MedWorm provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest medical blog items that have been tagged with 'acid'. Sat, 03 Sep 2011 01:57:51 +0100 http://www.medworm.com/index.php?rid=5181698&cid=t_210395_87_f&fid=34469&url=http%3A%2F%2Fwww.medrants.com%2Farchives%2F6448 To recap:   47-year-old woman found stuporous and hypotensive.  She has known alcohol abuse and decreased LVEF around 30%.   Her labs come back, and you should provide plausible reconstructions of these results. Fluid Balance Panel  110 59 38 73 3.2 30 2.2 8.0 Arterial Blood Gas on 2L nasal oxygen pH 7.57 pCO2 31 pO2 99 c HCO3 29 What do you think her acid-base diagnosis is?  What additional information do you want (history, physical and/or labs)? ======= New information: The ER gave 3000 cc of NS (plus a banana bag).  Her BP slowly increased. Her sodium increased from 110 to 120 over 6 hours.  You get back her serum osm – 240 and her urine osm – 150. Her lactic acid level confirms a mild lactic acidosis which... DB's Medical Rants blogs http://www.medworm.com/rss/comments.php?id=5181698 Thu, 01 Sep 2011 12:48:11 +0100 5181698 http://www.medworm.com/index.php?rid=5181699&cid=t_210395_87_f&fid=34469&url=http%3A%2F%2Fwww.medrants.com%2Farchives%2F6445 47-year-old woman found stuporous and hypotensive.  She has known alcohol abuse and decreased LVEF around 30%.   Her labs come back, and you should provide plausible reconstructions of these results.   Fluid Balance Panel  110 59 38 73 3.2 30 2.2 8.0   Arterial Blood Gas on 2L nasal oxygen   pH 7.57 pCO2 31 pO2 99 c HCO3 29 What do you think her acid-base diagnosis is?  What additional information do you want (history, physical and/or labs)? (Source: DB's Medical Rants) DB's Medical Rants blogs http://www.medworm.com/rss/comments.php?id=5181699 Tue, 30 Aug 2011 22:51:08 +0100 5181699 http://www.medworm.com/index.php?rid=5140183&cid=t_210395_136_f&fid=37846&url=http%3A%2F%2Fhealthinfoispower.wordpress.com%2F2011%2F08%2F17%2Fpenns-genetically-modified-t-cells-create-antitumor-effect-in-mice-with-folate-positive-ovarian-cancer-clinical-trial-pending%2F In a recent issue of Cancer Research, researchers from the University of Pennsylvania showed for the first time that engineered human T cells can eradicate deadly human ovarian cancer in immune-deficient mice. A clinical trial involving the modified T cells is expected to be announced within the next few months. In a recent issue of Cancer Research, Daniel [...] (Source: Libby's H*O*P*E*) Libby's H*O*P*E* blogs http://www.medworm.com/rss/comments.php?id=5140183 Wed, 17 Aug 2011 22:50:23 +0100 5140183 http://www.medworm.com/index.php?rid=5139645&cid=t_210395_87_f&fid=34469&url=http%3A%2F%2Fwww.medrants.com%2Farchives%2F6429 Kudos to torontointernist.  The Canadian understood the big clues.  Here we have a patient with a normal gap metabolic acidosis plus a proximal tubule leak – 2+ urine glucose with a normal serum glucose.  This suggests strongly Fanconi's syndrome.  I mentioned a chronic disease and a medication.  Several medications can cause Fanconi's, but the most likely in 2011 is tenofovir, an HIV drug. So Torontointernist nailed it using careful logic.  And db claps wildly!!! (Source: DB's Medical Rants) DB's Medical Rants blogs http://www.medworm.com/rss/comments.php?id=5139645 Wed, 17 Aug 2011 12:47:20 +0100 5139645 http://www.medworm.com/index.php?rid=5139646&cid=t_210395_87_f&fid=34469&url=http%3A%2F%2Fwww.medrants.com%2Farchives%2F6426 45-year–old man with a chronic disease, gets admitted for increased creatinine and abnormal urinalysis.  His previous creatinine was less than 1.0. 140 107 9 105 4.1 21 1.9   ABG confirms metabolic acidosis with appropriate compensation. U/A includes 2+ protein, 2+ glucose, 2+ blood U Na 24, K 12, Cl 18 Day 2 K drops to 3.1, Phos 1.8, Mg 2.1 What is the underlying disease, and what medication caused these abnormalities?   (Source: DB's Medical Rants) DB's Medical Rants blogs http://www.medworm.com/rss/comments.php?id=5139646 Tue, 16 Aug 2011 12:32:40 +0100 5139646 http://www.medworm.com/index.php?rid=5096207&cid=t_210395_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fliquid-material-may-someday-be-used-to-restore-damaged-soft-tissue%2F2011.08.04 Yesterday, I came across this press release from Johns Hopkins regarding a new composite material which may someday be used to restore damaged soft tissue.  (photo credit) The liquid material is a composite of biological and synthetic molecules which is injected under the skin.  Transdermal light is then used to “set” the material into a more solid structure. The results of the early experiments in rats and humans has been reported in the July 27 issue of Science Translational Medicine (full reference below). It is hoped that the new liquid material is a biosynthetic soft tissue replacement composed of poly(ethylene glycol) (PEG) and hyaluronic acid (HA). From the press release (more…) *This blog post was originally published at Suture for a Living* (Source: B... Better Health blogs http://www.medworm.com/rss/comments.php?id=5096207 Thu, 04 Aug 2011 12:00:00 +0100 5096207 http://www.medworm.com/index.php?rid=5069404&cid=t_210395_87_f&fid=34469&url=http%3A%2F%2Fwww.medrants.com%2Farchives%2F6396 To repeat: 44-year-old man has had a recent drinking binge.  He has fallen several times (unclear whether this is syncope or not)     Fluid Balance Panel (6 pm) 137 92 15 91 4.9 16 0.7     Arterial Blood Gas(midnight)   pH 7.45 pCO2 30 pO2 84 c HCO3 21 What do you think his acid-base diagnosis is?  What tests would you order? He initially had a significant anion gap.  His U/A was positive for ketones, but a serum ketone test was negative.  He had a slightly elevated lactate of 6.2.  I suspect he came in with a mild lactic acidosis and perhaps alcoholic ketoacidosis.  These problems resolved quickly, explaining his ABG results 6 hours later. We had a confusing issue – his serum osms on the initial blood equal... DB's Medical Rants blogs http://www.medworm.com/rss/comments.php?id=5069404 Wed, 27 Jul 2011 12:02:03 +0100 5069404 http://www.medworm.com/index.php?rid=5050457&cid=t_210395_87_f&fid=34469&url=http%3A%2F%2Fwww.medrants.com%2Farchives%2F6387 44-year-old man has had a recent drinking binge.  He has fallen several times (unclear whether this is syncope or not)   Fluid Balance Panel (6 pm) 137 92 15 91 4.9 16 0.7     Arterial Blood Gas(midnight)   pH 7.45 pCO2 30 pO2 84 c HCO3 21 What do you think his acid-base diagnosis is?  What tests would you order? (Source: DB's Medical Rants) DB's Medical Rants blogs http://www.medworm.com/rss/comments.php?id=5050457 Tue, 19 Jul 2011 16:48:15 +0100 5050457 http://www.medworm.com/index.php?rid=4952843&cid=t_210395_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fnew-study-supports-previous-evidence-that-autism-is-triggered-in-utero%2F2011.06.21 Science has found no evidence that vaccines cause autism; but the true cause(s) of autism have not yet been determined. So far the available evidence has pointed towards a largely genetic cause with possible interaction with environmental factors. A new study supports that interpretation. It also supports previous evidence that autism is triggered prior to birth, rather than at the time of vaccinations. Schmidt et al. published a study in Epidemiology on May 23, 2011, entitled “Prenatal Vitamins, One-carbon Metabolism Gene Variants, and Risk for Autism.” It was a population-based case control study of 566 subjects comparing a group of autistic children to a matched control group of children with normal development. They looked at maternal intake of prenatal vitamins in the 3 months bef... Better Health blogs http://www.medworm.com/rss/comments.php?id=4952843 Tue, 21 Jun 2011 14:00:43 +0100 4952843 http://www.medworm.com/index.php?rid=4934021&cid=t_210395_87_f&fid=34469&url=http%3A%2F%2Fwww.medrants.com%2Farchives%2F6347 60-year-old man admitted for 3-5 days of nausea, vomiting (undigested food), watery diarrhea (volume not specified) and alcohol on his breath. Patient has significant orthostasis with pulse increase (just raising head of bed).  PMH of hypertension – only prescribed metoprolol. Predict the electrolyte disorders and acid base disorders. There are no surprises here – we predicted the direction of everything at morning report. 139 75 13 159 2.3 15 1.3     Unfortunately we do not have an ABG, but we can get quite close to the truth. First, I assumed that an alcohol abuser with vomiting and watery diarrhea would have significant hypokalemia.  That is the easiest prediction. Second, we cannot predict the sodium level.  The patient would likely have vol... DB's Medical Rants blogs http://www.medworm.com/rss/comments.php?id=4934021 Thu, 16 Jun 2011 12:23:39 +0100 4934021 http://www.medworm.com/index.php?rid=4934022&cid=t_210395_87_f&fid=34469&url=http%3A%2F%2Fwww.medrants.com%2Farchives%2F6345 A 60+ year old man was admitted for a 1 day history of abdominal pain, hematochezia, and a rash developing over his lower extremities bilaterally.  No significant PMH other than chronic pain. H&P revealed a history of nausea and vomiting the day previous to admission with 6 bright red bloody stools and diffuse abdominal pain. Later that day he noticed a rash developing over his left foot which eventually progressed to involve both lower extremities to the knee. Exam was notable for a benign abdomen and palpable, nonblanching petechiae present from the soles proximally to the thighs.  Physical exam is otherwise unremarkable.   Labs:   WBC 12.3k H/H 13.4/40.7 Plts 389k   134 100 42 136 5.4 26 2.8 8.2 UA – moderate protein, 6 hyaline casts, + bacter... DB's Medical Rants blogs http://www.medworm.com/rss/comments.php?id=4934022 Wed, 15 Jun 2011 22:41:22 +0100 4934022 http://www.medworm.com/index.php?rid=4934023&cid=t_210395_87_f&fid=34469&url=http%3A%2F%2Fwww.medrants.com%2Farchives%2F6343 60-year-old man admitted for 3-5 days of nausea, vomiting (undigested food), watery diarrhea (volume not specified) and alcohol on his breath. Patient has significant orthostasis with pulse increase (just raising head of bed).  PMH of hypertension – only prescribed metoprolol. Predict the electrolyte disorders and acid base disorders. There are no surprises here – we predicted the direction of everything at morning report. 139 75 13 159 2.3 15 1.3   (Source: DB's Medical Rants) DB's Medical Rants blogs http://www.medworm.com/rss/comments.php?id=4934023 Wed, 15 Jun 2011 22:36:21 +0100 4934023 http://www.medworm.com/index.php?rid=4934024&cid=t_210395_87_f&fid=34469&url=http%3A%2F%2Fwww.medrants.com%2Farchives%2F6341   A 60+ year old man was admitted for a 1 day history of abdominal pain, hematochezia, and a rash developing over his lower extremities bilaterally.  No significant PMH other than chronic pain. H&P revealed a history of nausea and vomiting the day previous to admission with 6 bright red bloody stools and diffuse abdominal pain. Later that day he noticed a rash developing over his left foot which eventually progressed to involve both lower extremities to the knee. Exam was notable for a benign abdomen and palpable, nonblanching petechiae present from the soles proximally to the thighs.  Physical exam is otherwise unremarkable.   Labs:   WBC 12.3k H/H 13.4/40.7 Plts 389k   134 100 42 136 5.4 26 2.8 8.2 UA – moderate protein, 6 hyaline casts, +... DB's Medical Rants blogs http://www.medworm.com/rss/comments.php?id=4934024 Tue, 14 Jun 2011 20:19:04 +0100 4934024 http://www.medworm.com/index.php?rid=4893457&cid=t_210395_88_f&fid=38129&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2Flifeinthefastlane%2FWZHV%2F%7E3%2FSen8YuWqphg%2F Some fun figures well worth engraving on the surface of your encephalon if you're an emergency or critical care doc in this week's FFFF. (Source: Life in the Fast Lane) Life in the Fast Lane blogs http://www.medworm.com/rss/comments.php?id=4893457 Fri, 03 Jun 2011 00:00:23 +0100 4893457 http://www.medworm.com/index.php?rid=4893339&cid=t_210395_87_f&fid=34469&url=http%3A%2F%2Fwww.medrants.com%2Farchives%2F6320 60-year-old man admitted for 3-5 days of nausea, vomiting (undigested food), watery diarrhea (volume not specified) and alcohol on his breath. Patient has significant orthostasis with pulse increase (just raising head of bed).  PMH of hypertension – only prescribed metoprolol. Predict the electrolyte disorders and acid base disorders. There are no surprises here – we predicted the direction of everything at morning report. (Source: DB's Medical Rants) DB's Medical Rants blogs http://www.medworm.com/rss/comments.php?id=4893339 Thu, 02 Jun 2011 14:32:28 +0100 4893339 http://www.medworm.com/index.php?rid=4803146&cid=t_210395_88_f&fid=38129&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2Flifeinthefastlane%2FWZHV%2F%7E3%2FRL51oCgViVc%2F The LITFL Review is your regular and reliable source for the highest highlights, sneakiest sneak peaks and loudest shout-outs from the webbed world of emergency medicine and critical care (Source: Life in the Fast Lane) Life in the Fast Lane blogs http://www.medworm.com/rss/comments.php?id=4803146 Mon, 02 May 2011 05:51:07 +0100 4803146 http://www.medworm.com/index.php?rid=4734114&cid=t_210395_88_f&fid=38129&url=http%3A%2F%2Fwww.emergencyweb.net%2Flibrary%2Fmp3.php%3Ff%3Deits_ep039_als_review_2010.mp3 The LITFL Review is your regular and reliable source for the highest highlights, sneakiest sneak peaks and loudest shout-outs from the webbed world of emergency medicine and critical care. (Source: Life in the Fast Lane) Life in the Fast Lane blogs http://www.medworm.com/rss/comments.php?id=4734114 Mon, 18 Apr 2011 03:55:11 +0100 4734114 http://www.medworm.com/index.php?rid=4709209&cid=t_210395_88_f&fid=38129&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2Flifeinthefastlane%2FWZHV%2F%7E3%2FfxqSH9JDGF4%2F Is it safe to give a patient frusemide if he has an allergy to sulfa drugs? Are you feeling slightly immunologically discombobulated? The answer's here. (Source: Life in the Fast Lane) Life in the Fast Lane blogs http://www.medworm.com/rss/comments.php?id=4709209 Wed, 13 Apr 2011 07:38:13 +0100 4709209 http://www.medworm.com/index.php?rid=4676787&cid=t_210395_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fheartburn-bugs-have-become-antibiotic-resistant%2F2011.04.04 H. pylori dominated the GI news in the 1990s, and despite it disappearing from the front pages, it remains a common and important clinical problem. The dominant recommended initial treatment strategy has been a clarithromycin-based PPI triple therapy, with either amoxicillin or metronidazole as the third drug. This approach was based on clinical studies, ease of use, and tolerability factors. Bismuth-based quadruple therapy (a bismuth agent, metronidazole, tetracycline, and a PPI), despite demonstrating excellent activity, was usually relegated to second-line therapy because of the complexity of the dosing as well as compliance and tolerability issues. However, duringthe last decade, the widespread use of macrolides in the general population has led to rising resistance to clarithromycin (... Better Health blogs http://www.medworm.com/rss/comments.php?id=4676787 Mon, 04 Apr 2011 18:00:07 +0100 4676787 http://www.medworm.com/index.php?rid=4610773&cid=t_210395_87_f&fid=34469&url=http%3A%2F%2Fwww.medrants.com%2Farchives%2F6188 Happy Hospitalist enjoys interpreting arterial blood gases.  I wonder if he enjoys electrolyte panels as much.  I do love lab test interpretation (all lab tests) because as a diagnostician (med talk for detective) I want to take advantage of every possible clue. Extreme Metabolic Alkalosis: Classic Blood Gas Physiology Management Simply Explained\ We become really good at fixing abnormal blood gases, or at least getting them to a stable base line.   If you are ever being pimped by your attending and the question involves a blood gas, the answer will almost always be administer saline first, ask questions later.  Medical students, keep this in mind the next time your attending asks you about that anion gap metabolic acidosis.   That may not fly with Dr Centor duri... DB's Medical Rants blogs http://www.medworm.com/rss/comments.php?id=4610773 Fri, 18 Mar 2011 22:12:02 +0100 4610773 http://www.medworm.com/index.php?rid=4507242&cid=t_210395_87_f&fid=34469&url=http%3A%2F%2Fwww.medrants.com%2Farchives%2F6132 50-something year-old woman is admitted for weakness.  She has a history of chronic diarrhea.  She has had type II DM for over 15 years.  Her labs are remarkable: Fluid Balance Panel 137 113 48 163 5.6 14 1.5   Arterial Blood Gas pH 7.24 pCO2 36 pO2 79 c HCO3 16 What do you think her acid-base diagnosis is?  How do you prove it, i.e., what further tests do you order? First, the patient is not taking any RAS blockers (ACE-I, ARB or spironalactone). Urine lytes: Na 58 K 22 Cl 65 Thus UAG = +15, and acidosis is due to impaired buffering Urine Osm = 362, calculated TTKG = 3.2.  In the presence of hyperkalemia, this low TTKG supports hypoaldesteronism. The patient has type IV RTA – hyporenin, hypoaldo – commonly associated with diabe... DB's Medical Rants blogs http://www.medworm.com/rss/comments.php?id=4507242 Mon, 21 Feb 2011 20:16:18 +0100 4507242 http://www.medworm.com/index.php?rid=4495160&cid=t_210395_87_f&fid=34469&url=http%3A%2F%2Fwww.medrants.com%2Farchives%2F6124 Presented this week at morning report: 50-something year-old woman is admitted for weakness.  She has a history of chronic diarrhea.  She has had type II DM for over 15 years.  Her labs are remarkable: Fluid Balance Panel 137 113 48 163 5.6 14 1.5   Arterial Blood Gas pH 7.24 pCO2 36 pO2 79 c HCO3 16 What do you think her acid-base diagnosis is?  How do you prove it, i.e., what further tests do you order? (Source: DB's Medical Rants) DB's Medical Rants blogs http://www.medworm.com/rss/comments.php?id=4495160 Fri, 18 Feb 2011 17:32:52 +0100 4495160 http://www.medworm.com/index.php?rid=4472950&cid=t_210395_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fconsumer-health-information-the-new-third-party-in-the-exam-room%2F2011.02.13 It was sometime in the mid-nineties that parents started showing up in my office with reams of paper. Inkjet printouts of independently unearthed information pulled from AltaVista and Excite. Google didn’t exist. In the earliest days of the Web, information was occasionally leveraged by families as a type of newfound control. A young father and his inkjet printer One case sticks clearly in my mind. It was that of a toddler with medically unresponsive acid reflux and chronic lung disease. After following the child for some time, the discussion with the family finally moved to the option of a fundoplication (anti-reflux surgery). On a follow-up visit the father had done his diligence and appeared in the office with a banker box brimming with printed information. He had done his homewo... Better Health blogs http://www.medworm.com/rss/comments.php?id=4472950 Sun, 13 Feb 2011 16:00:39 +0100 4472950 http://www.medworm.com/index.php?rid=4429057&cid=t_210395_109_f&fid=34750&url=http%3A%2F%2Fpsychcentral.com%2Fblog%2Farchives%2F2011%2F02%2F02%2F10-winter-depression-busters-for-groundhog-day%2F I don’t really care if that bloody woodchuck emerges from its hole to see its shadow or not today (Ed. – He did not, so an early spring is predicted). History tells this depressed person that we still have a good 30 to 40 days to endure really crappy weather, during which we should employ every sanity exercise available. Let’s call a spade a spade: winter sucks for some of us. So, little marmot, I don’t care what you do. I don’t care if you get yourself a nice rat for dinner, I’m sticking to these techniques regardless! Here are a few of my favorite winter depression busters… 1. Watch the sugar. I think our body gets the cue just before Thanksgiving that it will be hibernating for a few months, so it needs to ingest everything edible in sight. And... World of Psychology blogs http://www.medworm.com/rss/comments.php?id=4429057 Wed, 02 Feb 2011 19:39:58 +0100 4429057 http://www.medworm.com/index.php?rid=4399466&cid=t_210395_87_f&fid=34469&url=http%3A%2F%2Fwww.medrants.com%2Farchives%2F6077 The most important teaching point here is that the markedly elevated phosphate explains the increased anion gap.  I have probably seen this about 4 times in the past 5 years.  I agree with the comments that the FeNa is very high, suggesting acute tubular necrosis.  The rapid correction suggests that the patient was in the diuretic phase. Another possibility is that the patient had extreme volume contraction, and had the urine lytes checked after receiving significant IV fluids.  I do not know the exact time frame, but this is clearly a possibility. The serum osms were 296 and the ethylene glycol level was negative.  Calcium oxalate crystals in the urine are sensitive but not specific for ethylene glycol.  Fortunately, fomipazole only costs ~$500 now (it is ge... DB's Medical Rants blogs http://www.medworm.com/rss/comments.php?id=4399466 Wed, 26 Jan 2011 13:23:34 +0100 4399466 http://www.medworm.com/index.php?rid=4394387&cid=t_210395_87_f&fid=34469&url=http%3A%2F%2Fwww.medrants.com%2Farchives%2F6072 To recount:     Na 124 Cl 71 BUN 99 glu 114 K 5.5 CO2 31 creat 6.6       ABG on room air pH 7.46 pCO2 18 pO2 70 calc HCO3 13 Step 1 Define the acid-base problem. Several readers understood that the ABG does not fit the BMP.  Let us start with the BMP. 1. We have an increased anion gap – 22 – therefore we should explain the unknown anion 2. We have an increased bicarbonate and when we consider the delta gap, it is very high 3. Surprisingly we have a normal K (usually low in volume contraction) 4. We have a marked elevation in BUN and creatinine, suggesting acute renal failure 5. From the ABG we see a respiratory alkalosis, probably explained by hypoxemia – note the very large A-a gradient I suspect the ABG was drawn at a ve... DB's Medical Rants blogs http://www.medworm.com/rss/comments.php?id=4394387 Tue, 25 Jan 2011 13:00:48 +0100 4394387 http://www.medworm.com/index.php?rid=4382756&cid=t_210395_87_f&fid=36941&url=http%3A%2F%2Fwww.mazecordblood.com%2Fblog%2F%3Fp%3D1074 Folic acid, in combination with vitamin B-12 and vitamin C, is considered essential by health care providers for women that are planning pregnancy.  Being on a healthy diet and adding a daily dose of 400 micrograms of folic acid in a multivitamin along with folic acid rich foods is highly recommended by researchers and midwives. A lack of dietary folic acid leads to folate deficiency  (FD). This can result in many health problems, the most notable one being neural tube defects in developing embryo. Read here for more information on how much folic acid you need for a healthy pregnancy. (Source: Cord Blood News) Cord Blood News blogs http://www.medworm.com/rss/comments.php?id=4382756 Sat, 22 Jan 2011 02:17:40 +0100 4382756 http://www.medworm.com/index.php?rid=4372001&cid=t_210395_87_f&fid=34469&url=http%3A%2F%2Fwww.medrants.com%2Farchives%2F6063 They saved this one for me for 6 months!  Here is the intro as written by an excellent resident: 52 yo WM with hx of heroin use presented to ER from jail for AMS, nausea, vomiting, and diarrhea.  Pt was arrested 2 days prior to presentation, and per guard had been somewhat confused but ambulating normally.  No other details elicited from guard or pt.  PE:   AF  147/96 (unable to do orthostatics 2/2 too unstable to stand)  HR 82   O2 sat 96% on 2L NC Physical exam notable for cachectic appearing WM awake but lethargic and not answering questions.  Track marks noted to bilateral upper extremities.  Dry mucous membranes.  Lungs clear.  Abd benign.  Foley w/ ~200 cc urine in bag after ~1 liter in ER.  Co... DB's Medical Rants blogs http://www.medworm.com/rss/comments.php?id=4372001 Wed, 19 Jan 2011 18:09:42 +0100 4372001 http://www.medworm.com/index.php?rid=4309564&cid=t_210395_87_f&fid=34816&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FHonestMedicine%2F%7E3%2FBMUfBL4I-zc%2Fintegrative-physicians-praise-the-just-published-honest-medicine.html Drs. Julian Whitaker, Ronald Hoffman, Jeffrey Dach—and others—praise HONEST MEDICINE. Those of you who have read my just-published book, HONEST MEDICINE: Effective, Time-Tested, Inexpensive Treatments for Life-Threatening Diseases, know that several well-known integrative doctors have written testimonials for it. I have included them in the book. I am very grateful to these doctors for their support, and would like to thank them here by sharing their kind words with you. In another post, I will share the testimonials of several others. But for now. . . Julian Whitaker, MD, Founder of the Whitaker Wellness Institute, Editor of Health & Healing newsletter, and author of many best-selling books, including Dr. Whitaker’s Guide to Natural Healing, Reversing Diabetes and Reversin... HONEST MEDICINE: My Dream for the Future blogs http://www.medworm.com/rss/comments.php?id=4309564 Mon, 03 Jan 2011 21:33:40 +0100 4309564 http://www.medworm.com/index.php?rid=4294553&cid=t_210395_83_f&fid=34856&url=http%3A%2F%2Finsidesurgery.com%2F2010%2F12%2Fzollingerellison-syndrome%2F Pathophysiology group of pathologic conditions caused by hypersecretion of gastric acid secondary to a gastrinoma Signs and Symptoms 1) peptic ulcer often in second-fourth part of duodenum or in jejunum 2) diarrhea (often steatorrhea-like) 3) gastric bleeding/hematemesis 4) melena 5) duodenal perforation 6) epigastric tenderness Characteristic Test Findings Laboratory – 1) fasting serum gastrin > 1000 pg/ml 2) basal acid output (BAO) > 15 mEq/h 3) hypercalcemia (if part of MEN-1) 4) BAO to MAO > 0.6 5) increase in gastrin in secretin stimulation test Radiology – 6) hypertrophied gastric folds similar to Menetrier’s disease on upper GI series 7) gastrinoma often not seen on CT scan or MRI 8) visceral angiography may show tumor blush and enable localization 9) somatostatin ... Inside Surgery blogs http://www.medworm.com/rss/comments.php?id=4294553 Tue, 28 Dec 2010 01:19:12 +0100 4294553 http://www.medworm.com/index.php?rid=4266300&cid=t_210395_160_f&fid=36189&url=http%3A%2F%2Fwww.skinmdblog.com%2F330%2Fnatural-skin-care-ingredients-for-an-anti-aging-facial%2F An anti aging facial treatment may perhaps be utilized on an infrequent or a frequent basis, it all depends on the formulation of the product.   Facial treatments at the spa are high-priced, but everyone likes to indulge on occasion.   But it is the product you use on a daily basis that tends to make the largest difference. What makes the most difference is selecting a natural skin care product that can generate healthful skin holistically instead of deciding on purely superficial solutions. It is hard to believe that a lot of the most popular elements provide no real benefit.   They are preferred because of misinformation spun by the cosmetic industry. For instance, collagen does nothing when applied to your skin.  The processes used to soften it destroy its bioactivity.  The skin�... Skin MD blogs http://www.medworm.com/rss/comments.php?id=4266300 Wed, 15 Dec 2010 13:06:54 +0100 4266300 http://www.medworm.com/index.php?rid=4219698&cid=t_210395_87_f&fid=34469&url=http%3A%2F%2Fwww.medrants.com%2Farchives%2F5969 Any day you get published in the NEJM is a good day.  As of 5 p.m. today, you can read a very interesting Clinical Problem Solving case that I participated in – In Search of . . . This patient fit my definition of a "great case", because after a struggle to make the diagnosis the patient had a great response to treatment.  The diagnostic struggle made a difference. I particularly like this case because it takes a common internal medicine differential and likely expands it for many readers.  Here's hoping that you enjoy this story as much as we did. (Source: DB's Medical Rants) DB's Medical Rants blogs http://www.medworm.com/rss/comments.php?id=4219698 Thu, 02 Dec 2010 01:32:22 +0100 4219698 http://www.medworm.com/index.php?rid=4207252&cid=t_210395_83_f&fid=34856&url=http%3A%2F%2Finsidesurgery.com%2F2010%2F11%2Fprimary-fibrinolysis%2F Primary fibrinolysis is a rare condition that occurs when the body releases an abnormally high amount of tissue plasminogen activator from tissues that causes diffuse and sometimes uncontrollable bleeding. It can occur in sepsis, cardiopulmonary bypass, and transurethral prostate resection (TURP) which can cause release of urokinase from the prostate. In bleeding suspected secondary to primary fibrinolysis, use of antifibrinolytic agents Amicar (aminocaproic acid) and Transamin (tranexamic acid) can be quite helpful. (Source: Inside Surgery) Inside Surgery blogs http://www.medworm.com/rss/comments.php?id=4207252 Mon, 29 Nov 2010 07:46:37 +0100 4207252 http://www.medworm.com/index.php?rid=4197066&cid=t_210395_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Folive-oil-and-your-skin%2F2010.11.23 Trying to keep up with what’s hot in skincare is like trying to keep up with the Kardashians. It’s impossible (not that I’ve tried with the Kardashians, that is.) Then how are you to know what are the latest and greatest ingredients? Well, you could read The Derm Blog (when I get around to posting on it), or you could just listen to your grandmother. Some of the newest discoveries in skin care aren’t new at all: Olive oil may be seem hot now, but countless Mediterranean grandmothers, including mine, have sworn by its skin-care benefits for centuries (millenia?) Were they right? Olive oil contains caffeic acid, oleic acid, and oleuropein — all of which are potent antioxidants. Unlike berries or teas, these antioxidants are already in oil, allowing them to be directly applied t... Better Health blogs http://www.medworm.com/rss/comments.php?id=4197066 Tue, 23 Nov 2010 23:00:38 +0100 4197066 http://www.medworm.com/index.php?rid=4168009&cid=t_210395_109_f&fid=34750&url=http%3A%2F%2Fpsychcentral.com%2Fblog%2Farchives%2F2010%2F11%2F15%2Fmyths-and-facts-about-alcohol%2F What’s the truth about alcohol? Does food help absorb alcohol? Does it really kill brain cells? Or does it protect your body against a multitude of diseases, like heart disease? One of the key factors that helps us process and breakdown alcohol after it enters the body is the production of an enzyme called alcohol dehydrogenase. A lot of why your body does or doesn’t do a good job in breaking alcohol down and sobering you up has to do with the production (or lack thereof) of this important enzyme. This enzyme works better in younger men than in either women of all ages, or older men. Why, we don’t know, but it seems to stop working as effectively in men ages 55 and older, bringing them closer to women in their alcohol breaking-down ability. LifeHacker recently published a... World of Psychology blogs http://www.medworm.com/rss/comments.php?id=4168009 Mon, 15 Nov 2010 17:44:35 +0100 4168009 http://www.medworm.com/index.php?rid=4164506&cid=t_210395_87_f&fid=34469&url=http%3A%2F%2Fwww.medrants.com%2Farchives%2F5930 So we went to the bedside.  The patient appeared unhappy and uncomfortable. My questions started with the nausea and vomiting, but quickly we moved to the patient's job.  He had a recent promotion to a supervisory position.  Since that time sleep was restless and never adequate.  He was anhedonic, and cried often.  During the interview he started crying.  He had lost 20 pounds in the past month due to decreased appetite. So I thought that I had solved the entire problem – depression and generalized anxiety disorder. And that was a big part of his problem, but probably did not explain his frequent vomiting.  My colleague focused on the vomiting and asked if taking showers improved his symptoms.  She suggested a diagnosis of cannabinoid hyper... DB's Medical Rants blogs http://www.medworm.com/rss/comments.php?id=4164506 Mon, 15 Nov 2010 00:39:34 +0100 4164506 http://www.medworm.com/index.php?rid=4155208&cid=t_210395_87_f&fid=34469&url=http%3A%2F%2Fwww.medrants.com%2Farchives%2F5921 I know that I say this almost every day.  When I am confused, I retreat to the bedside and start again.  Often when residents and students present patients I feel that an important clue is missing.  Going to the bedside can provide that clue. This is a case where the labs spurred a bedside visit and a diagnosis. The patient is 30 something.  The patient complained of sudden onset of vomiting early in the morning, coming to the ER 3 hours later, still having frequent dry heaves.  He/she admitted to frequent vomiting, but this episode was worse.  He/she also complained of loose stools since a cholecystectomy when a teenager. These labs confused me:   140 105 7 4.4 19 0.8 The glucose is normal.  The albumin is 5. We then got an ABG.  Step 1... DB's Medical Rants blogs http://www.medworm.com/rss/comments.php?id=4155208 Thu, 11 Nov 2010 12:01:17 +0100 4155208 http://www.medworm.com/index.php?rid=4125289&cid=t_210395_151_f&fid=35818&url=http%3A%2F%2Frecoveryissexy.com%2Fdental-recovery%2F This article may help but one may also consider seeing a dentist. With all the whitening and brightening products available for your teeth, it’s easy to forget that cosmetics aren’t enough to achieve a healthy mouth. There’s regular brushing and flossing, of course, but your teeth and gums need even more. Like the rest of your body, good health in your mouth starts with getting the right dietary nutrients. What you eat makes a difference in whether your gums, teeth and the bone they attach to are able to stand strong against plaque bacteria that can cause disease. Among the dental health nutritional standouts: Calcium: The more milk, cheese and yogurt you consume, the less likely you are to develop periodontal, or gum, disease, a chronic bacterial infection. Calcium is i... Recovery Is Sexy.com blogs http://www.medworm.com/rss/comments.php?id=4125289 Thu, 28 Oct 2010 16:51:02 +0100 4125289 http://www.medworm.com/index.php?rid=4085979&cid=t_210395_146_f&fid=38266&url=http%3A%2F%2Fsleepeducation.blogspot.com%2F2010%2F10%2Facid-reflux-heartburn-and-your-sleep.html (Source: Sleep Education) Sleep Education blogs http://www.medworm.com/rss/comments.php?id=4085979 Tue, 19 Oct 2010 22:52:00 +0100 4085979 http://www.medworm.com/index.php?rid=4119043&cid=t_210395_107_f&fid=36672&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSciencebaseScienceBlog%2F%7E3%2F4cQazzTxTXw%2Fgerds-dirty-little-secret.html GERD’s dirty little secret – When omeprazole's patent expired AstraZeneca launched the optically pure version esomeprazole, which is apparently four times as active and gave them a new patent and a corner of the acid reflux market. Bizarrely, both forms of the drug (pro-drug in fact) are converted to the same chemical in the body and so you could get the same efficacy level as esomeprazole simply by taking more of the original omeprazole, which of course is now available as a much cheaper generic since the AZ patent expired. Another opportunity for NHS or health insurance savings? Related Posts:Chene Follow UCesamet, THC and chemotherapyPatently ObviousTrue body shapeCholesterol drug withdrawal symptomsGERD’s dirty little secret is a post from: Sciencebase Science Blog (... Sciencebase Science Blog blogs http://www.medworm.com/rss/comments.php?id=4119043 Tue, 19 Oct 2010 17:00:00 +0100 4119043 http://www.medworm.com/index.php?rid=4073526&cid=t_210395_139_f&fid=38879&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FVirologyBlog%2F%7E3%2FvHqbPksYzRM%2F This week’s addition to the virology toolbox was written by Chris Upton Generating multiple sequence alignments (MSA) is one of the most commonly used bioinformatics techniques. The “sequences” to be compared can be DNA (promoters, genes, genomes) or proteins. Note that the length and number of sequences to be aligned has an impact on the methods (algorithms) that can be used; what is suitable for aligning 20 proteins probably won’t work for alignment of 5 poxvirus genomes (200 kb each). Some useful links: Wikipedia: multiple sequence alignment Wikipedia: sequence alignment Wikipedia: list of sequence alignment software Protein Multiple Sequence Alignment: Book chapter by Chuong B. Do and Kazutaka Katoh Sequence alignment: Lecture notes by Per Kraulis Another list of tools So yo... virology blog blogs http://www.medworm.com/rss/comments.php?id=4073526 Fri, 15 Oct 2010 16:24:12 +0100 4073526 http://www.medworm.com/index.php?rid=4053382&cid=t_210395_117_f&fid=38856&url=http%3A%2F%2Fwww.timemastermd.com%2F%3Fp%3D1319 Who would have thought that celery could turn out to be far more effective than Viagra or any other sex-enhancing drug ever produced? This green tasteless vegetable is loaded down with excellent amounts of vitamin E, magnesium, niacin, potassium and zinc – all required for optimum sex. Elizabeth Shreve really has a unique way of expressing herself – I like it! It gets even better. Celery contains arginine, a natural amino acid that expands blood vessels much like Viagra. Yet, unlike Viagra, arginine also increases blood flow to the clitoris and makes female genitals more responsive. Furthermore, the actual aroma of celery contains two steroids called androsterone and androstenol. The research showed that the subtle odor of these two chemicals travels through the nose and attra... Timemaster MD blogs http://www.medworm.com/rss/comments.php?id=4053382 Sun, 10 Oct 2010 13:38:47 +0100 4053382 http://www.medworm.com/index.php?rid=4036592&cid=t_210395_87_f&fid=34469&url=http%3A%2F%2Fwww.medrants.com%2Farchives%2F5851 Periodically we get a patient admitted with profound hyponatremia < 105.  These patients generally have a great risk for developing a demyelination syndrome.  This case report discusses a novel and logical strategy to avoid having the sodium level increase too rapidly.  They recommend a combination of 3% NS and desmopressin with a goal of 6 mEq/day.  The link is to the abstract, I recommend that all hospitalists get the article, read it and study it.  It will likely help you avoid a dreaded complication.  Treating Profound Hyponatremia: A Strategy for Controlled Correction (Source: DB's Medical Rants) DB's Medical Rants blogs http://www.medworm.com/rss/comments.php?id=4036592 Wed, 06 Oct 2010 11:05:16 +0100 4036592 http://www.medworm.com/index.php?rid=4013117&cid=t_210395_87_f&fid=34872&url=http%3A%2F%2Fblisstree.com%2Ffeel%2F202211%2F Birth Control, Meet Folic Acid: Beyaz, a new birth control pill that was just approved by the FDA, contains folic acid. (via CNN) Post from: BlissTree (Source: Healthbolt) Healthbolt blogs http://www.medworm.com/rss/comments.php?id=4013117 Tue, 28 Sep 2010 17:21:57 +0100 4013117 http://www.medworm.com/index.php?rid=3998920&cid=t_210395_87_f&fid=34469&url=http%3A%2F%2Fwww.medrants.com%2Farchives%2F5825 Now the resident on the 5th day asks me why the bicarbonate is depressed.  The patient is stuporous on benzodiazepines.  He is breathing 16 times per minute (my own count) and snoring loudly.  We cannot do a good exam at this time.   136 105 8 3.6 16 0.6 What do you tell the resident? This post is dedicated to Happy and Cory.  They both agree on getting an ABG. We obtained one and the patient was breathing room air.  Do they agree on anything else? pH 7.4 pCO2 23 pO2 74 calc HCO3 15 Now what do you think and what do you do? (Source: DB's Medical Rants) DB's Medical Rants blogs http://www.medworm.com/rss/comments.php?id=3998920 Fri, 24 Sep 2010 13:48:16 +0100 3998920 http://www.medworm.com/index.php?rid=3993819&cid=t_210395_87_f&fid=34469&url=http%3A%2F%2Fwww.medrants.com%2Farchives%2F5819 60+ year old man admitted for altered mental status – he is well known to our hospital and a heavy alcoholic 117 82 6 3.3 26 0.6 The glucose is normal This is part 1 – what tests do you order?  What further information do you want?  Do you start treatment? Clues – no seizures, no alcohol in blood Serum osms = 245 Urine osms = 90 Therefore beer potomania However, the patient goes into DTs.  The team increases his sodium slowly (2 days to achieve 130). Now the resident on the 5th day asks me why the bicarbonate is depressed.  The patient is stuporous on benzodiazepines.  He is breathing 16 times per minute (my own count) and snoring loudly.  We cannot do a good exam at this time.   136 105 8 3.6 16 0.6 What do you tel... DB's Medical Rants blogs http://www.medworm.com/rss/comments.php?id=3993819 Wed, 22 Sep 2010 18:47:45 +0100 3993819 http://www.medworm.com/index.php?rid=3983380&cid=t_210395_87_f&fid=34469&url=http%3A%2F%2Fwww.medrants.com%2Farchives%2F5813 60+ year old man admitted for altered mental status – he is well known to our hospital and a heavy alcoholic 117 82 6 3.3 26 0.6 The glucose is normal This is part 1 – what tests do you order?  What further information do you want?  Do you start treatment? Clues – no seizures, no alcohol in blood Several more parts ensue (Source: DB's Medical Rants) DB's Medical Rants blogs http://www.medworm.com/rss/comments.php?id=3983380 Sun, 19 Sep 2010 11:01:56 +0100 3983380 http://www.medworm.com/index.php?rid=3896118&cid=t_210395_160_f&fid=36189&url=http%3A%2F%2Fwww.skinmdblog.com%2F255%2Fwass-your-wrinkle-cream-highly-rated-in-clinical-trials%2F Media coverage and production of anti wrinkle cream ratings in order to help people choose which product is best are in many cases leading the public astray. Oftentimes there is some sort of incentive mired in why a few specific products are chosen for these infamous “top ten lists”, and it more often than not has to do with either money or advertising dollars.  These products are not often selected because of their safety or effectiveness. Take the instant wrinkle removers that could cause you to lose part or total control over the muscles in your face as a perfect example.  The skin care products don’t help with the loss of collagen, elastin, or hyaluronic acid due to enzyme processes , and they don’t do a thing to boost tissue growth. Is it really worth ... Skin MD blogs http://www.medworm.com/rss/comments.php?id=3896118 Mon, 23 Aug 2010 13:33:36 +0100 3896118 http://www.medworm.com/index.php?rid=3862152&cid=t_210395_136_f&fid=37846&url=http%3A%2F%2Fhealthinfoispower.wordpress.com%2F2010%2F08%2F12%2Fthe-cancer-biomarker-conundrum-too-many-false-discoveries%2F The boom in cancer [including ovarian] biomarker investments over the past 25 years has not translated into major clinical success. The reasons for biomarker failures include problems with study design and interpretation, as well as statistical deficiencies, according to an article published online August 12 in The Journal of the National Cancer Institute. The boom [...] (Source: Libby's H*O*P*E*) Libby's H*O*P*E* blogs http://www.medworm.com/rss/comments.php?id=3862152 Fri, 13 Aug 2010 04:40:30 +0100 3862152 http://www.medworm.com/index.php?rid=3861969&cid=t_210395_87_f&fid=34469&url=http%3A%2F%2Fwww.medrants.com%2Farchives%2F5720 The diagnosis is not tricky, but I do have a few questions:   Na 121 Cl 73 BUN 57 glu 1820 K 9.6 CO2 6 creat 3.2     Has anyone seen a higher glucose? A higher K? Postulate the sequence of events leading to these numbers Background information – 17 year history of type I DM.  Several recent admissions for DKA, but usually with blood glucose lower than 1000. ABG  pH 7.20 pCO2 17 pO2 324 calc HCO3 17 Here are the numbers the next morning and the following day Na 145 Cl 105 BUN 49 glu 909 K 4.9 CO2 14 creat 2.5     Na 143 Cl 108 BUN 14 glu 110 K 3.6 CO2 23 creat 0.9     Some additional information: The patient presented unconscious and hypotensive He required intubation for several hours He has multiple ... DB's Medical Rants blogs http://www.medworm.com/rss/comments.php?id=3861969 Thu, 12 Aug 2010 14:05:48 +0100 3861969 http://www.medworm.com/index.php?rid=3854482&cid=t_210395_87_f&fid=34469&url=http%3A%2F%2Fwww.medrants.com%2Farchives%2F5709 The diagnosis is not tricky, but I do have a few questions:   Na 121 Cl 73 BUN 57 glu 1820 K 9.6 CO2 6 creat 3.2 Ca++   Has anyone seen a higher glucose? A higher K? Postulate the sequence of events leading to these numbers Background information – 17 year history of type I DM.  Several recent admissions for DKA, but usually with blood glucose lower than 1000. ABG  pH 7.20 pCO2 17 pO2 324 calc HCO3 17   (Source: DB's Medical Rants) DB's Medical Rants blogs http://www.medworm.com/rss/comments.php?id=3854482 Tue, 10 Aug 2010 19:24:06 +0100 3854482 http://www.medworm.com/index.php?rid=3833415&cid=t_210395_87_f&fid=34469&url=http%3A%2F%2Fwww.medrants.com%2Farchives%2F5705 To repeat the problem: 26-year-old man comes in for flank pain.  He has a history of renal stones.  It is August in Alabama, he has been working outside.  He does state that he has been drinking and urinating.     Na 139 Cl 92 BUN 28 glu 128 K 4.5 CO2 22 creat 2.5 Ca++ 10.6  These lab tests led to his admission.  What can you glean from these labs?  Postulate on the cause of these numbers. The comments were spot on – increased anion gap acidosis (gap 25) and metabolic alkalosis (delta gap of approximately 13 with a normal bicarb) The patient was markedly volume contracted.  We explained his anion gap from his phosphate level of 9.6.  After volume expansion his phosphate returned to normal, as did his increased gap.  His c... DB's Medical Rants blogs http://www.medworm.com/rss/comments.php?id=3833415 Sat, 07 Aug 2010 11:33:05 +0100 3833415 http://www.medworm.com/index.php?rid=3822864&cid=t_210395_87_f&fid=34469&url=http%3A%2F%2Fwww.medrants.com%2Farchives%2F5701 26-year-old man comes in for flank pain.  He has a history of renal stones.  It is August in Alabama, he has been working outside.  He does state that he has been drinking and urinating.     Na 139 Cl 92 BUN 28 glu 128 K 4.5 CO2 22 creat 2.5 Ca++ 10.6  These lab tests led to his admission.  What can you glean from these labs?  Postulate on the cause of these numbers. (Source: DB's Medical Rants) DB's Medical Rants blogs http://www.medworm.com/rss/comments.php?id=3822864 Thu, 05 Aug 2010 01:35:31 +0100 3822864 http://www.medworm.com/index.php?rid=3730103&cid=t_210395_151_f&fid=35818&url=http%3A%2F%2Frecoveryissexy.com%2Fis-diet-cola-bad-for-alcoholics-addicts%2F Conclusion There seems to be a small proportion of people who are sensitive and have side effects from drinking diet colas and eating foods with the sweetener aspartame. Two groups of people who may be sensitive to aspartame, and ethanol in particular, are alcoholics and drug addicts. Indeed anyone who has abused any drug or medication. For these people will have damaged their bodies and especially the liver and kidneys. Some alcoholics / addicts may also have PKU or an inherited sensitivity to phenylalanine. The Cure? The absolute cure is abstinence from all artificial sweeteners. Now this may be hard as most prepared foods contain some artificial sweeteners. You will need to find your own safe level. Detoxification When you stop using aspartame you may experience some acute withdr... Recovery Is Sexy.com blogs http://www.medworm.com/rss/comments.php?id=3730103 Tue, 06 Jul 2010 19:05:59 +0100 3730103 http://www.medworm.com/index.php?rid=3729848&cid=t_210395_87_f&fid=36050&url=http%3A%2F%2Fblisstree.com%2Flive%2Fwhat-does-your-hair-color-say-about-your-health%2F photo: Thinkstock We all love our hair. (Or we hate it.) We preen over it for way too long in the morning, we spend months deciding on a new cut or color, and definitely think our luscious locks add to our feminine wiles. But apparently, our hair can even alert us to possible health risks. Check out what your natural hair color could say about your well being, courtesy of Women’s Health: Blondes You’re at risk for developing age-related macular degeneration (AMD), an eye condition that can lead to blindness. Eat food rich in lutein and zeaxanthin, like kale, spinach, and snow peas. Blondes are also at the highest risk for melanoma. Make sure you wear a full-spectrum SPF 30, and wear a hat in direct sunlight. Check out some of our favorite eco-friendly hats here. Brunettes Y... Breastfeeding 1-2-3 blogs http://www.medworm.com/rss/comments.php?id=3729848 Tue, 06 Jul 2010 17:49:48 +0100 3729848 http://www.medworm.com/index.php?rid=3726575&cid=t_210395_87_f&fid=34469&url=http%3A%2F%2Fwww.medrants.com%2Farchives%2F5632 2 days ago I posed a question about low anion gaps.  I found this list: Decreased anion gap * Acidemia: Causes dissociation of protons from plasma proteins, decreasing their negative charge. * Decreased albumin: A very common cause of a lower than expected or decreased anion gap. * Assay artefacts: Artefactually elevated chloride, e.g. bromide therapy. * Dilution: Dilutes plasma proteins. * Increased unmeasured cations: Calcium, magnesium, gamma globulins, lithium. (These rarely cause an increased anion gap as most increases are incompatible with life. It is unusual to see a low anion gap in multiple myeloma.) The "pimp questions" include bromide and lithium.  While this is often a pimp question, you get the anion gap at no extra cost when you get a basic me... DB's Medical Rants blogs http://www.medworm.com/rss/comments.php?id=3726575 Mon, 05 Jul 2010 10:44:16 +0100 3726575 http://www.medworm.com/index.php?rid=3724421&cid=t_210395_83_f&fid=34856&url=http%3A%2F%2Finsidesurgery.com%2F2010%2F07%2Fsnake-oil-snake-oil%2F Snake oil is a traditional Chinese medicine obtained from the Chinese water snake Enhydris chinensis. Although it is still sold in traditional Chinese pharmacies as a legitimate remedy for pain and inflammation, especially in rheumatoid arthritis and other joint conditions, in the United States the term snake oil is used to denote a product that is misleading, worthless, or fraudulent. Despite this perjorative use of the term snake oil, studies show that the substance likely has real physiological and medicinal benefits. Snake oil from the Chinese water snake contains 20% of eicosapentaenoic acid (EPA), which is the highest concentration found in nature (in contrast, salmon oil contains about 16-18% EPA.) EPA is one of the precursor molecules found in the prostaglandin pathway and is highl... Inside Surgery blogs http://www.medworm.com/rss/comments.php?id=3724421 Sun, 04 Jul 2010 18:31:18 +0100 3724421 http://www.medworm.com/index.php?rid=3723297&cid=t_210395_87_f&fid=34469&url=http%3A%2F%2Fwww.medrants.com%2Farchives%2F5628 I love this story – Shopping at the GAP Can you provide other causes of a low (or even negative) anion gap? (Source: DB's Medical Rants) DB's Medical Rants blogs http://www.medworm.com/rss/comments.php?id=3723297 Sat, 03 Jul 2010 10:50:50 +0100 3723297 http://www.medworm.com/index.php?rid=3714183&cid=t_210395_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fsummertime-acne-facts%2F2010.06.30 With blonde hair and big blue eyes, she looked like a young Betty Draper from Mad Men. My patient, Julie, had been faithfully treating her acne for months. Just when it was starting to clear up (in time for her senior photos) — wham! – red dots cropped up over her forehead and cheeks. What went wrong? Summertime. July can be the cruelest month for acne. Acne on the chest and back (bacne) and big, red pimples on your face can make going to the beach an embarrassing experience. (more…) *This blog post was originally published at The Dermatology Blog* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=3714183 Wed, 30 Jun 2010 22:00:12 +0100 3714183 http://www.medworm.com/index.php?rid=3714122&cid=t_210395_87_f&fid=34469&url=http%3A%2F%2Fwww.medrants.com%2Farchives%2F5578 This article will add several important teaching points to my standard hyponatremia discussion.  If you have a significant interest in hyponatremia, I recommend the article.  I believe all hospitalists should be experts in hyponatremia. (Source: DB's Medical Rants) DB's Medical Rants blogs http://www.medworm.com/rss/comments.php?id=3714122 Wed, 30 Jun 2010 12:52:52 +0100 3714122 http://www.medworm.com/index.php?rid=3690807&cid=t_210395_87_f&fid=36050&url=http%3A%2F%2Fblisstree.com%2Flive%2F7-ways-that-germs-can-be-good-for-you-and-why-you-should-think-twice-before-taking-antibiotics%2F Germs, especially bacteria, have a fairly tarnished reputation among health circles, but according to Martin Blaser, chairman of the department of medicine at New York University Medical School, we might actually need more of them. The former president of the Infectious Disease Society of America says that our use of antibiotics and antibacterial products has reduced the number of healthy bacteria in our digestive tracts, changing our digestion and contributing to the rise in obesity. According to an article from Forbes.com, he’s not the only one who thinks that bacteria could be a good thing: They’ve compiled a list of ways that germs can actually be good for you, backed up by research from several scientists: 1. Controlling Weight – According to research from Cornell Univer... Breastfeeding 1-2-3 blogs http://www.medworm.com/rss/comments.php?id=3690807 Wed, 23 Jun 2010 19:57:12 +0100 3690807 http://www.medworm.com/index.php?rid=3662930&cid=t_210395_150_f&fid=35777&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FPharmalot%2F%7E3%2FlG3_0WmNlLQ%2F Rise and shine. Another day is on the way. To top it off, the sun is shining here on the Pharmalot corporate campus, where we are hustling the short people off to the schoolhouse. Wish us luck. Meanwhile, there is much to do. So why not start with the mandatory cup of stimulation and the news of the world. Have a great day, everyone… Glaxo Wins FDA OK For Prostate Combo Drug (Reuters) Cheap Generic May Save Lives After Bleeding From Accidents (Bloomberg News) ACRO Wants More US & European Trial Investigators (Outsourcing Pharma) Waiting For The Human Genome To Yield Drugs (The New York Times) Georgia Creates Bioscience Center (Atlanta Journal-Constitution) Cleveland Clinics Inks Research Deal With Lipitor Creator (Crain’s Cleveland Business) (Source: Pharmalot) Pharmalot blogs http://www.medworm.com/rss/comments.php?id=3662930 Tue, 15 Jun 2010 11:54:48 +0100 3662930 http://www.medworm.com/index.php?rid=3662605&cid=t_210395_83_f&fid=34856&url=http%3A%2F%2Finsidesurgery.com%2F2010%2F06%2Fwidely-drug-tranexamic-acid-shown-decrease-hemorrhage-trauma-deaths%2F British epidemiologist Dr. Ian Roberts of the London School of Hygiene and Tropical Medicine is reporting that the use of tranexamic acid (TXA), a cheap, widely available drug used to stop hemorrhage can decrease deaths by 15% if given to trauma patients. (Source: Inside Surgery) Inside Surgery blogs http://www.medworm.com/rss/comments.php?id=3662605 Tue, 15 Jun 2010 03:02:53 +0100 3662605 http://www.medworm.com/index.php?rid=3640968&cid=t_210395_87_f&fid=34469&url=http%3A%2F%2Fwww.medrants.com%2Farchives%2F5534 30 something patient with HIV dementia, comes in with depressed mental status.  CD4 count 17, no HAART therapy.  Long standing diabetes mellitus and CKD stage III.  Albumin 2.4.   170 143 39 79 4.2 13 2.6   What are the problems? The patient has new hypernatremia.  The patient lived at home and was left alone for periods of the day.  The patient could not get to water.  The CKD prevented the patient from maximally concentrating the urine.  The fixed urine output exacerbated the problem.  The patient has a mildly increased anion gap (14 with expected gap of 7) and an underlying normal gap acidosis.  We obtained an ABG pH 7.30 pCO2 28 pO2 81 HCO3 14 This ABG confirmed the mixed acidosis.  The CKD was unchanged from previo... DB's Medical Rants blogs http://www.medworm.com/rss/comments.php?id=3640968 Tue, 08 Jun 2010 01:29:46 +0100 3640968 http://www.medworm.com/index.php?rid=3632237&cid=t_210395_87_f&fid=34469&url=http%3A%2F%2Fwww.medrants.com%2Farchives%2F5528 30 something patient with HIV dementia, comes in with depressed mental status.  CD4 count 17, no HAART therapy.  Long standing diabetes mellitus and CKD stage III.  Albumin 2.4.             170 143 39 79 4.2 13 2.6   What are the problems?  What fluids do you want to give? (Source: DB's Medical Rants) DB's Medical Rants blogs http://www.medworm.com/rss/comments.php?id=3632237 Fri, 04 Jun 2010 22:11:44 +0100 3632237 http://www.medworm.com/index.php?rid=3625797&cid=t_210395_160_f&fid=36189&url=http%3A%2F%2Fwww.skinmdblog.com%2F143%2Fskin-peels-with-citric-malic-lactic-hydroxy-and-glycolic-acids%2F Skin peels are offered by spas, dermatologists and cosmetic surgeons.  A mild chemical peel can be purchased over the counter.  Here’s a look at the different ingredients and what they can do for you. Citric Acids Citric acids can be derived from any citrus fruit.  Limes, lemons, oranges and pineapples are commonly used in skincare products, especially daily cleansers. While the mild acids will not provide a significant improvement after a single application, when used on a daily basis they may provide a gradual improvement.  They work to break up excessive oil and dead skin cells, which is beneficial for whiteheads, blackheads and acne prevention. Lactic and Malic Acid Many of the over-the-counter exfoliants contain a combination of citric, lactic and malic acids.  Lactic acid may ... Skin MD blogs http://www.medworm.com/rss/comments.php?id=3625797 Thu, 03 Jun 2010 13:40:45 +0100 3625797 http://www.medworm.com/index.php?rid=3614495&cid=t_210395_83_f&fid=34856&url=http%3A%2F%2Finsidesurgery.com%2F2010%2F05%2Ffarbers-disease%2F Pathophysiology disseminated lipogranulomatosis of infancy and early childhood owing to defect in ceramidase Signs and Symptoms 1) onset of swollen, painful joints shortly after birth 2) weak cry 3) severely stunted growth and motor development 4) large yellow-red nodules on areas of mechanical stress (wrists, fingers, elbows, knees, and toes) 5) stridor – owing to growths on vocal cords and epiglottis 6) growths in nervous system Histology/Gross Pathology infiltration of skin with foamy histiocytes, granulomas, and eventual fibrosis (nervous system does not develop granulomas) Associated Conditions 1) nodular thickening of heart valves 2) retinal degeneration Biochemistry 1) ceramidase is a lysosomal acid that breaks ceramide into fatty acid and sphingosine 2) tissues have 10-60 tim... Inside Surgery blogs http://www.medworm.com/rss/comments.php?id=3614495 Mon, 31 May 2010 02:18:21 +0100 3614495 http://www.medworm.com/index.php?rid=3577577&cid=t_210395_135_f&fid=35274&url=http%3A%2F%2Facidrefluxweb.com%2F%3Fp%3D4455 Since my life is about transparency – and yesterday in my life of sobriety, I slipped. Not in a got out and get some tina and a case of beer, but with pot and lots of Ativan over the last two days. I’ve asked a friend for some to deal with some anxiety I was experience, as I’m super easily prone to irrational panic attacks. Instead of taking a couple, I took four or five before going to bed, and then another  couple when I work up as there was something coming up I was feeling anxious about. What I hadn’t realized was that I had gone into full addict mode. The meeting I had was a disaster that morning. In the moment I thought I was perfectly together, but afterwards when I realized I didn’t really remember much about what I had said, I know this was not something I could hide un... acidrefluxweb.com blogs http://www.medworm.com/rss/comments.php?id=3577577 Wed, 19 May 2010 15:04:44 +0100 3577577 http://www.medworm.com/index.php?rid=3570025&cid=t_210395_135_f&fid=35274&url=http%3A%2F%2Facidrefluxweb.com%2F%3Fp%3D4448 To switch things up a bit, I’ve started vblogging again – vblog is video blogging, and not “visitor blogging” for any of the sci-fi buffs out there. (Source: acidrefluxweb.com) acidrefluxweb.com blogs http://www.medworm.com/rss/comments.php?id=3570025 Mon, 17 May 2010 12:47:58 +0100 3570025 http://www.medworm.com/index.php?rid=3566590&cid=t_210395_87_f&fid=34872&url=http%3A%2F%2Fblisstree.com%2Ffeel%2Fwomen-and-pregnancy-happy-with-or-without-a-baby%2F photo: Thinkstock Having a baby isn’t something most people take lightly. Usually couples are actively trying to conceive, or are taking precautions to avoid having a child – right? Actually, almost 1/4 of women between  25-45 who were surveyed in a recent study said that they weren’t trying to have a child or avoiding having a child, and that they’d be content either way. In a world where you can micromanage ever minute detail of your life with your smart phone, it’s almost refreshing to hear that some women are comfortable letting whatever happens happen. But the results of this study suggest that there will have to be a change in the way health care providers interact with women of child-bearing age. Currently, when a women is asked if she’s trying to ... Healthbolt blogs http://www.medworm.com/rss/comments.php?id=3566590 Fri, 14 May 2010 20:13:46 +0100 3566590 http://www.medworm.com/index.php?rid=3549523&cid=t_210395_135_f&fid=35274&url=http%3A%2F%2Facidrefluxweb.com%2F%3Fp%3D4439 Ever since I went to see this famous French performer, and gay icon, Mylène Farmer, I’ve fallen in love with her opening song for the concert held at le Stade de France.  You know the place which houses the uber sexy “Les Dieux de Stade” Knowing Myléne’s penchant for dark lyrics, I hummed along to Paradis Inanimé not really thinking about the lyrics. Essentially it’s about being dead laying there spread out on granite forsaken by heaven, to die is to be loved, to die is to be immortal. You’d think I should be on suicide watch for liking this song, and I play it all the time. But I have no intention to taking any form a razor blade to these wrists anytime soon. They way I look at it, I haven’t made it this far in life thinking I only had 5 to 7 years to live back when I f... acidrefluxweb.com blogs http://www.medworm.com/rss/comments.php?id=3549523 Mon, 10 May 2010 15:37:25 +0100 3549523 http://www.medworm.com/index.php?rid=3542903&cid=t_210395_160_f&fid=36189&url=http%3A%2F%2Fwww.skinmdblog.com%2F56%2Fremoving-warts-with-duct-tape%2F Common warts are thickened, crusty lesions with noticeable black pinpoint dots. Contrary to what most people think, these aren’t caused by frog’s urine. They are caused by a virus called the human papilloma virus (HPV). There are a lot of ways to get rid of these pesky lesions but every technique aims to destroy the virus. You can apply an over-the-counter salicylic acid gel or solution, freeze it with liquid nitrogen, zap it with a laser or have it cauterized but I think the cheapest way to do it is to use duct tape. That’s right, DUCT TAPE!. Simply cut a piece of duct tape and apply it on the wart then leave it on for 7 days. On the eighth day, take it off and repeat the process until the wart disappears. It may take a month or two for it to completely resolve . This isn’t a guar... Skin MD blogs http://www.medworm.com/rss/comments.php?id=3542903 Fri, 07 May 2010 14:44:43 +0100 3542903 http://www.medworm.com/index.php?rid=3534055&cid=t_210395_135_f&fid=35274&url=http%3A%2F%2Facidrefluxweb.com%2F%3Fp%3D4435 The very first thing that struck me about Mark was his openness, and his sense of humour. Then when I saw the video clip (you can see in this post below) of him winning a car on The Price is Right with Bob Barker, the deal was sealed, I really liked this guy. This is a PositiveLite.com feature interview: I first got to know Mark through his blog on The Body (there is a link to it at the end of the post). When launching this site we began chatting on Facebook, and thought he was the perfect person with which to start off the PositiveLite.com interviews. Mark has been doing what I’ve been aspiring to do for quite some time, and that is use multi-media (i.e. video, writing, images) in a blog format covering all sorts of great topics, and with his flare for writing and wit. Mark’... acidrefluxweb.com blogs http://www.medworm.com/rss/comments.php?id=3534055 Wed, 05 May 2010 13:30:51 +0100 3534055 http://www.medworm.com/index.php?rid=3526970&cid=t_210395_160_f&fid=36189&url=http%3A%2F%2Fwww.skinmdblog.com%2F38%2Fcan-oral-supplements-prevent-wrinkles%2F I recently came across an ad in the magazine for an oral supplement that claims to fight dull, wrinkled, pimpled skin.  It boasts of 11 “essential” nutrients which are mainly antioxidants plus some other ingredients.  Taken daily, the pills hold promise of glowing skin in a couple of months. I don’t know about pimples but there is growing evidence that oral antioxidants could help slow down the wrinkling process or even improve existing wrinkles. The problem is that there are a lot of antioxidants available.  How do we know which ones really work? What is the best way to get them to work on the skin? It has been shown that selenium taken at 50 to 200 micrograms daily, vitamin E at 400mg /day and vitamin C at 500-1000mg (all known antioxidants) can protect against harmful UV rays w... Skin MD blogs http://www.medworm.com/rss/comments.php?id=3526970 Sat, 01 May 2010 15:15:31 +0100 3526970 http://www.medworm.com/index.php?rid=3511726&cid=t_210395_135_f&fid=35274&url=http%3A%2F%2Facidrefluxweb.com%2F%3Fp%3D4433 Now for the real news. I’m a sore loser, let’s just get that out there right away. When I entered my video for the Kathy Griffin contest, I wanted to win it, and get the meet and greet. Technically I can say that I did win, but as “second place” with two of getting a set of tickets to go. They flipped a coin to who would get to meet KG, and the other person got that as well. I want to be bitter, but I’m not. Even my friend said, “I’m bitter on your behalf!” I have to say I was quite disappointed for about five minutes. The better description was more like baffled as the winning video, in not only my opinion, kind of sucked. There are just way too many great things going on in my life at the moment that if I were to be really bummed out or bitter over this, I... acidrefluxweb.com blogs http://www.medworm.com/rss/comments.php?id=3511726 Wed, 28 Apr 2010 12:29:02 +0100 3511726 http://www.medworm.com/index.php?rid=3505095&cid=t_210395_135_f&fid=35274&url=http%3A%2F%2Facidrefluxweb.com%2F%3Fp%3D4428 A friend told me that The Star ran an article yesterday on The Jane Hotel, the place I stayed when I went to NYC to see Kathy Griffin with my friend Barry.  I should find my little video I made with them waving good-bye to us dressed in their old-school hotel uniform. It is a very cool place to stay, and cheap! Only steps away from any number, or should I say letter of twelve-step recovery house for the sober girl on the go. There valuable shopping time at steak, you want every possible retail experience only a stone’s throw away. It’s nice to know that my friend and I were a head of the curve of this establishment, once again showing how I can still pull off my glamorous lifestyle of the moderately poor and infected. Today I’m off to Hamilton where Brenda, Jim (both Positi... acidrefluxweb.com blogs http://www.medworm.com/rss/comments.php?id=3505095 Mon, 26 Apr 2010 12:53:00 +0100 3505095 http://www.medworm.com/index.php?rid=3490820&cid=t_210395_135_f&fid=35274&url=http%3A%2F%2Facidrefluxweb.com%2F%3Fp%3D4424 and maybe a trip to Milwaukee… Today is my sober three-year anniversary date, and all I fracken wanted was to win the Kathy Griffin contest as the crowning achievement of my sobriety. I’m not sure if it’s an actual achievement, but hell, what started out as a joke potentially turning out to really coming to fruition is achievement in my books. But now, Team Griffin is taking their sweet time to decide between two videos on who is going to get to meet Kathy. So I’m feeling a bit bitter now, and am moving on from this. That’s not to say, when, not if they call,  I won’t be excited as all hell and the entire city of Toronto won’t be hearing me squeal like a little girl who just got her first Easyback oven, and tickets to Disneyland. But for now, my ... acidrefluxweb.com blogs http://www.medworm.com/rss/comments.php?id=3490820 Wed, 21 Apr 2010 12:48:36 +0100 3490820 http://www.medworm.com/index.php?rid=3479645&cid=t_210395_87_f&fid=34969&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FUnboundedMedicine%2F%7E3%2F3F3mL2_MAbc%2F Kidney stones (nephrolithiasis or urolithiasis) affect approximately 12% of men and 5% of women during their lifetime. Nearly half of all first time stone formers will have another stone episode within the next four years. Stones can form when calcium, oxalate, uric acid or cystine are at high levels in the urine. Uric acid stones represents 5 – 10% of all kidney stones. But they comprise 40% in areas with hot/arid climates where low urine volume and acid urine pH promote uric acid precipitation. Prevalence:  In patients with gout without antihyperuricemic treatment is 20%. Hundreds-fold greater than healthy adults. Risk factors: It primarily occurs in patients without abnormality in uric acid metabolism such as: relatively high serum uric acid levels, comparatively low urinary pH,... Unbounded Medicine blogs http://www.medworm.com/rss/comments.php?id=3479645 Fri, 16 Apr 2010 19:01:55 +0100 3479645 http://www.medworm.com/index.php?rid=3476024&cid=t_210395_135_f&fid=35274&url=http%3A%2F%2Facidrefluxweb.com%2F%3Fp%3D4419 I keep listening to this song which takes me back to when I was in Paris having one of those moments where I thought to myself, “Take this in man, cause it’s one of those special moments when things just couldn’t be more special and perfect.” The reason to why I’m doing this is not exactly to relive past moments. Presently I feel as if life is taking some interesting and exciting directions. So much so that these days have been about ten years in the making. I kid you not. The more I put myself out there on the path that is truest to me, the more people and opportunities come into my life. It’s been happening more and more. On April 21st, I will arrive at my third anniversary from my slip in Mexico that lead to my crowning of “Miss Don Woods 2007,” the CAMH GLBT rehab progr... acidrefluxweb.com blogs http://www.medworm.com/rss/comments.php?id=3476024 Fri, 16 Apr 2010 15:23:31 +0100 3476024 http://www.medworm.com/index.php?rid=3475762&cid=t_210395_87_f&fid=34469&url=http%3A%2F%2Fwww.medrants.com%2Farchives%2F5435 To recap 50 something man admitted to our service after being found unresponsive.  He is well known to our hospital, is homeless, an alcoholic and has a seizure disorder. In the ER he is found to have bilateral lower lobe pneumonia, and an alcohol level of 426.  He becomes hypotensive, requires intubation and pressors.  The resident presents these laboratory tests:   Na 138 Cl 109 BUN 15 glu 151 K 3.9 CO2 15 creat 1.0     On 50 % oxygen: pH 7.29 pCO2 33 pO2 86 HCO3 16 Over 24 hours we were able to extubate the patient and discontinue the pressors.  He became alert, but without any memory of his admission. I had speculated about his acid base status on presentation.  I needed more information.  His albumin was 4.  Previou... DB's Medical Rants blogs http://www.medworm.com/rss/comments.php?id=3475762 Fri, 16 Apr 2010 12:16:04 +0100 3475762 http://www.medworm.com/index.php?rid=3467701&cid=t_210395_87_f&fid=34469&url=http%3A%2F%2Fwww.medrants.com%2Farchives%2F5423 50 something man admitted to our service after being found unresponsive.  He is well known to our hospital, is homeless, an alcoholic and has a seizure disorder. In the ER he is found to have bilateral lower lobe pneumonia, and an alcohol level of 426.  He becomes hypotensive, requires intubation and pressors.  The resident presents these laboratory tests:   Na 138 Cl 109 BUN 15 glu 151 K 3.9 CO2 15 creat 1.0     On 50 % oxygen: pH 7.29 pCO2 33 pO2 86 HCO3 16   1. What is his acid-base disorder? 2. Speculate on an etiology. 3. How would you treat him? (Source: DB's Medical Rants) DB's Medical Rants blogs http://www.medworm.com/rss/comments.php?id=3467701 Tue, 13 Apr 2010 20:51:21 +0100 3467701 http://www.medworm.com/index.php?rid=3460355&cid=t_210395_135_f&fid=35274&url=http%3A%2F%2Facidrefluxweb.com%2F%3Fp%3D4413 I’m so close to meeting Kathy Griffin with this contest, details and link in today’s post at the bottom for the video, and my poetic writing, ah plea. See the last post for the video, and please watch it. I managed to get 374 people to watch it in a week. My one and only competitor in this contest has 100, and her video isn’t that great. Plus, when I went to the forum on the Kathy Griffin site to add something to my contest post where the link to my video is found, I saw a note to me from the Team Griffin Webmaster. Now for those who don’t know I made a video to win a DVD. When I went to submit it, I saw I missed the bloody deadline. Disappointed, I shared it with friends etc, and it still has gotten about 450 viewings. In the video I say that I was not successful meeting K... acidrefluxweb.com blogs http://www.medworm.com/rss/comments.php?id=3460355 Mon, 12 Apr 2010 12:05:21 +0100 3460355 http://www.medworm.com/index.php?rid=3443820&cid=t_210395_117_f&fid=38158&url=http%3A%2F%2Fwww.twitter.com%2Famacupuncturehttp%3A%2F%2Famericanacupuncture.blogspot.com%2F2010%2F04%2Flack-of-stomach-acid-causes-most-gerd.html As a medical physician for over 51 years, I strive to give you the best medical information on controversial medical subjects, and help your read betwwen the lines. You must come to your own conclusions. I have no ties to any organization, pharmaceutical, or lobby group. As an practicing medical acupuncturist since 1982, I find western medicine and medical acupuncture are very complimentary. This results in astounding healing in pain management, addictions to cigarettes and food, and a host of other maladies. Visit drneedles is blogging" at the end of each blog for a complete alphabetical list of all my blogsVisit http://www.americanacupuncture.com/ for more detailed information on mind, body, and spirit healing.LACK OF STOMACH ACID CAUSES MOST GERDGERD  has become a househo... Dr. Needles Medical Blogs blogs http://www.medworm.com/rss/comments.php?id=3443820 Mon, 05 Apr 2010 17:28:00 +0100 3443820 http://www.medworm.com/index.php?rid=3440917&cid=t_210395_117_f&fid=38158&url=http%3A%2F%2Fwww.twitter.com%2Famacupuncturehttp%3A%2F%2Famericanacupuncture.blogspot.com%2F2010%2F04%2Flack-of-stomach-acid-causes-most-gerd.html As a medical physician for over 51 years, I strive to give you the best medical information on controversial medical subjects, and help your read betwwen the lines. You must come to your own conclusions. I have no ties to any organization, pharmaceutical, or lobby group. As an practicing medical acupuncturist since 1982, I find western medicine and medical acupuncture are very complimentary. This results in astounding healing in pain management, addictions to cigarettes and food, and a host of other maladies. Visit drneedles is blogging" at the end of each blog for a complete alphabetical list of all my blogs Visit http://www.americanacupuncture.com/ for more detailed information on mind, body, and spirit healing. LACK OF STOMACH ACID CAUSES MOST GERDGERD  has become a household word.... Dr. Needles Medical Blogs blogs http://www.medworm.com/rss/comments.php?id=3440917 Mon, 05 Apr 2010 17:28:00 +0100 3440917 http://www.medworm.com/index.php?rid=3437876&cid=t_210395_135_f&fid=35274&url=http%3A%2F%2Facidrefluxweb.com%2F%3Fp%3D4409 Ok, here’s the deal. I didn’t want to look foolish after going to all the trouble of making this video to enter in a contest to win a free copy of Kathy Griffin’s latest DVD release, “She’ll Cut a Bitch.” I mean it was a lot of work for something I could have ordered off of Amazon for 15 bucks. That wasn’t the purpose, the purpose is that I want the video to be seen. So I released the video even though I knew I missed the deadline. However like a gift from little baby jesus himself, she has a new and even better contest: tickets to Pridefest, and a meet and greet. The I decided to go green and recycle my first video as I thought it was fabulous, and is the most popular video by far I’ve made so far in terms of viewing hits. Here is it, I&#821... acidrefluxweb.com blogs http://www.medworm.com/rss/comments.php?id=3437876 Mon, 05 Apr 2010 13:04:33 +0100 3437876 http://www.medworm.com/index.php?rid=3436367&cid=t_210395_135_f&fid=35274&url=http%3A%2F%2Facidrefluxweb.com%2F%3Fp%3D4405 A few days have gone by now that the hard launch for PositiveLite.Com – April 1st – to coincide with GayGuideToronto.Com’s 8th anniversary of its launch.  It was a fitting way to launch given the details outlined in the post below I wrote just as new PositiveLite.C0m site went live. There are a lot of great things happening at the moment. A new collaboration is evolving with XGen TV to form my own production company producing video content featured on XGen TV, as well on my sites — all of which will be mobile device accessible, including the newest Apple device, the iPad.  In addition, we’ll have professional camera work, and production – of course it’s all Crackhouse Productions. The Real Hags of Cabbagetown will actually get some resources, exp... acidrefluxweb.com blogs http://www.medworm.com/rss/comments.php?id=3436367 Sun, 04 Apr 2010 14:19:10 +0100 3436367 http://www.medworm.com/index.php?rid=3408323&cid=t_210395_87_f&fid=34469&url=http%3A%2F%2Fwww.medrants.com%2Farchives%2F5386 For those who are following the discussion of my most recent acid base question: I believe that the patient actually has two primary conditions – an increased anion gap acidosis and a respiratory alkalosis.  As I understand salicylate toxicity, this is the classic acid-base presentation.  I do not believe that the anion gap acidosis is compensatory. Related posts:Answer to weakness and confusion My thoughts on March 8 acid-base AMS – an acid-base problem II (Source: DB's Medical Rants) DB's Medical Rants blogs http://www.medworm.com/rss/comments.php?id=3408323 Fri, 26 Mar 2010 16:05:58 +0100 3408323 http://www.medworm.com/index.php?rid=3404089&cid=t_210395_135_f&fid=35274&url=http%3A%2F%2Facidrefluxweb.com%2F%3Fp%3D4392 Oh my god, it has taken me almost four days to return to normal after three days of non-stop a go-go to NYC and back last weekend. I don’t think I can do much more of these whirlwind trips any more; another sign I’m getting old and virally worn out. There was a time when I’d fly in Friday and fly out Sunday to any given city all the time, but come to think of it, it was tiring even 20 years ago. I’m not sure what made me think this was going to be any different. I do have to say, I was so off my game in NYC. The interview, although can be edited into something ok, my mind went a blank. This should have been a piece of cake interview after 20 years of doing this kind of stuff. Perhaps it was the fact that I wasn’t feeling well and was up since 4 am the night before leaving having ... acidrefluxweb.com blogs http://www.medworm.com/rss/comments.php?id=3404089 Thu, 25 Mar 2010 13:52:05 +0100 3404089 http://www.medworm.com/index.php?rid=3398853&cid=t_210395_87_f&fid=34469&url=http%3A%2F%2Fwww.medrants.com%2Farchives%2F5376 Presented at morning report: 56 yo man with known osteoarthritis and hyperlipidemia presents complaining of weakness and confusion   Na 140 Cl 105 BUN 18 glu 128 K 3.3 CO2 16 creat 0.9       pH 7.47 pCO2 24 pO2 74 HCO3 18   1. What is the acid-base disorder – be complete? 2. What additional tests do you want? 3. Provide at least 2 possible causes for these numbers. Related posts:March 8, 2010 – an acid base challenge My thoughts on March 8 acid-base The acid base book (Source: DB's Medical Rants) DB's Medical Rants blogs http://www.medworm.com/rss/comments.php?id=3398853 Tue, 23 Mar 2010 19:11:15 +0100 3398853 http://www.medworm.com/index.php?rid=3385510&cid=t_210395_135_f&fid=35274&url=http%3A%2F%2Facidrefluxweb.com%2F%3Fp%3D4389 Standing in my hotel room, I looked over to see a bunch of little girl ballerinas lifting their arms over their heads in Soviet like collective. It was at this point I thought it was best to close the blinds as I was only in my underwear about to press my shirt for tomorrow’s interview with Ongina here in New York. What a trip. This is my first time on my own since the crazy days. One of the nice thing about being a “citizen of the world” as one of my friends call me, is that immediately in any number of cities I instantly feel as if I am at home. New York is one of those cities for me. A cloud was cast over this trip, as things didn’t go so well with the arrangements around accommodations. The person with whom I was to stay had completely different set of expectati... acidrefluxweb.com blogs http://www.medworm.com/rss/comments.php?id=3385510 Sat, 20 Mar 2010 01:55:27 +0100 3385510 http://www.medworm.com/index.php?rid=3382426&cid=t_210395_139_f&fid=38879&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FVirologyBlog%2F%7E3%2FVZEtRry8oHQ%2F Last year a mutation in the HA gene of the 2009 H1N1 influenza virus was identified in isolates from patients with severe disease. At the time I concluded that the emergence of this change was not a concern. Recently the Norwegian Institute of Public Health reported that the mutation, which causes a change from the amino acid aspartic acid to glycine at position 225 of the viral HA protein (D225G), has been identified in 11 of 61 cases (18%) of severe or fatal influenza, but not in any of 205 mild cases. Have these observations changed my view of the importance of this mutation? The cell receptor for influenza A virus strains is sialic acid. Human influenza A strains bind preferentially to sialic acids linked to galactose by an alpha(2,6) bond, while avian and equine strains prefer alpha... virology blog blogs http://www.medworm.com/rss/comments.php?id=3382426 Fri, 19 Mar 2010 03:14:01 +0100 3382426 http://www.medworm.com/index.php?rid=3370621&cid=t_210395_135_f&fid=35274&url=http%3A%2F%2Facidrefluxweb.com%2F%3Fp%3D4379 It surprises me how many people noticed I changed my Facebook info. By doing so I entered this odd Facebook grey zone – relationship status. I had been getting messages from newly acquired FB friends recently that weren’t of the nature I’d be looking for on FB, such as the dick shot, or the watersports TMI message. Now for those who know me I’m not easily shocked. Perhaps I’m just becoming a prude in my old age. Call me old fashioned but I like to keep my Manhunt moments on Manhunt, and Facebook on Facebook. I hadn’t realized that I had several things checked off such as single, looking for relationship, friendship, and maybe networking of something. These went quickly. “No wonder.” I thought. In addition I have been seeing someone over the past few months. ... acidrefluxweb.com blogs http://www.medworm.com/rss/comments.php?id=3370621 Mon, 15 Mar 2010 22:16:30 +0100 3370621 http://www.medworm.com/index.php?rid=3359184&cid=t_210395_135_f&fid=35274&url=http%3A%2F%2Facidrefluxweb.com%2F%3Fp%3D4376 For the next little while my recent fab magazine conversation piece can be found here. I can honestly say that It was indeed a conversation starter. At least a comment generator as this is one of the pieces I’ve had the most people come up to me and say something. I haven’t been featuring my pieces on here, and I will get back to that as I’ve been a wee bit lazy. Hope you enjoy it. Not for the faint of heart when it comes to talking about “pee.” (Source: acidrefluxweb.com) acidrefluxweb.com blogs http://www.medworm.com/rss/comments.php?id=3359184 Fri, 12 Mar 2010 16:37:14 +0100 3359184 http://www.medworm.com/index.php?rid=3354251&cid=t_210395_87_f&fid=34469&url=http%3A%2F%2Fwww.medrants.com%2Farchives%2F5358 First, thanks to the great discussion.  Readers will learn as much from the discussion as they will from me.  To repeat the presentation: The patient is an 81 year old man found with altered mental status.  He has known diabetes mellitus, hypertension, COPD and CHF, but has not taken any medications for the past year. Electrolyte panel Na 142 Cl 96 BUN 99 K 5.5 HCO3 21 creat 2.3 Blood Sugar 568           Alb 3.1 ABG on 4 liters nasal oxygen ABG pH 7.38 pCO2 29 pO2 133 HCO3 18           So please address these questions: 1. What is the acid-base disorder? Great job here.  The patient has an increased anion gap – defining an increased anion gap metabolic acidosis.  Note that has expecte... DB's Medical Rants blogs http://www.medworm.com/rss/comments.php?id=3354251 Thu, 11 Mar 2010 13:41:22 +0100 3354251 http://www.medworm.com/index.php?rid=3354252&cid=t_210395_87_f&fid=34469&url=http%3A%2F%2Fwww.medrants.com%2Farchives%2F5356 We have a brilliant debate ongoing in the comment section of yesterday's problem.  I will refrain from commenting for 24 hours.  Please join the debate – then I will weigh in some time tomorrow. I cannot answer every question about this patient, but I can answer some key questions. Related posts:Duty hours – no easy answers (h/t @FutureDocs) 15 days at the VA – day 2 March 8, 2010 – an acid base challenge (Source: DB's Medical Rants) DB's Medical Rants blogs http://www.medworm.com/rss/comments.php?id=3354252 Wed, 10 Mar 2010 19:50:10 +0100 3354252 http://www.medworm.com/index.php?rid=3346650&cid=t_210395_135_f&fid=35274&url=http%3A%2F%2Facidrefluxweb.com%2F%3Fp%3D4372 I’m so excited with all the changes and opportunities that seem to be coming my way. First of all, I’m looking forward to my new working relationship with Shaun Proulx as PositiveLite.Com becomes a sister site to GayGuideToronto.Com, and part of Shaun Proulx Media. There are so many great ways that we can create synergies by combining our efforts, and I’m very much looking forward to the out come. At the end of the month, a couple improv friends are putting on an improv workshop for people living with HIV the AIDS Committee of Toronto on March 31st” I think this will be a lot of fun and encourage anyone who wants to explore their own sense of playfulness in safe environment, then come and join us. More info can be found on my Facebook Event Page. Last week I had a chance to see Joa... acidrefluxweb.com blogs http://www.medworm.com/rss/comments.php?id=3346650 Tue, 09 Mar 2010 17:53:53 +0100 3346650 http://www.medworm.com/index.php?rid=3346415&cid=t_210395_87_f&fid=34469&url=http%3A%2F%2Fwww.medrants.com%2Farchives%2F5353 The patient is an 81 year old man found with altered mental status.  He has known diabetes mellitus, hypertension, COPD and CHF, but has not taken any medications for the past year. Electrolyte panel Na 142 Cl 96 BUN 99 K 5.5 HCO3 21 creat 2.3 Blood Sugar 568 Alb 3.1 ABG on 4 liters nasal oxygen ABG pH 7.38 pCO2 29 pO2 133 HCO3 18 So please address these questions: 1. What is the acid-base disorder? 2.Provide a differential for the causes of the acid-base disorder? 3. What other information do you need? Related posts:A new acid-base problem An acidosis question Yesterday’s acid-base problem (Source: DB's Medical Rants) DB's Medical Rants blogs http://www.medworm.com/rss/comments.php?id=3346415 Mon, 08 Mar 2010 21:11:57 +0100 3346415 http://www.medworm.com/index.php?rid=3322581&cid=t_210395_135_f&fid=35274&url=http%3A%2F%2Facidrefluxweb.com%2F%3Fp%3D4357 I am in such a fog today. The ADD medication so has been pretty good. There have been a couple drawbacks. One is that I can get far too easily stressed out, and I have to watch that. The old habit of drinking a pot of coffee isn’t what it used to be. That might have been tolerable when I wasn’t adding any supplementary stimulants into my body. Not any more! Yesterday I felt so stressed over some things that I just took a break and enjoyed the beautiful sunny day on what would normally gloomy cold February day. It has been such exceptional winter weather wise that it seemed to be a waste worrying about things that are just a blip in the radar in life. Don’t me wrong; I’m far from being a basket case of nerves. But sometimes when things are bothering me, I have to foc... acidrefluxweb.com blogs http://www.medworm.com/rss/comments.php?id=3322581 Tue, 02 Mar 2010 15:57:48 +0100 3322581 http://www.medworm.com/index.php?rid=3316215&cid=t_210395_135_f&fid=35274&url=http%3A%2F%2Facidrefluxweb.com%2F%3Fp%3D4350 I’m asking everyone to be patient with me as I sort out my life vis-à-vis all my websites. What I’m thinking of doing is incorporating Acid Reflux into PositiveLite.Com, and then there will only one blog and one focus. My column on GayGuideToronto.Com is different from Acid Reflux in that I write about more topical issues, where I want to get back writing more frequently about what’s going on in my life, in addition to exploring video etc. I will let everyone know, and then I will be focused in one place. There are so many exciting things going on! My first one is a new medication, which is always exciting for me. I say that as dry sarcasm, and with a bit of truth depending on what the drug is. I went to my doc’s and told him about the winter depression. Since we&#... acidrefluxweb.com blogs http://www.medworm.com/rss/comments.php?id=3316215 Sun, 28 Feb 2010 15:56:08 +0100 3316215 http://www.medworm.com/index.php?rid=3283485&cid=t_210395_87_f&fid=34469&url=http%3A%2F%2Fwww.medrants.com%2Farchives%2F5305 The patient is a 69 year old woman admitted with abdominal pain and nausea.  She may have lost weight.  She has no known past medical history and is taking no medications.  Her labs give many clues: Electrolyte panel Na 142 Cl 113 BUN 106 K 6.5 HCO3 11 creat 9.1 Blood Sugar 79 Alb 3.2; Calcium 5.1 ABG on room air ABG pH 7.23 pCO2 23 pO2 80 HCO3 10 So please address these questions: 1. What is the acid-base disorder? Here is my approach.  Anion gap = 18.  Therefore, the patient has an increased anion gap acidosis by definition.  The expected gap is approximately 9 (note the albumin). The delta gap is 9; adding to 11 (the HCO3 ) gives an estimated prior bicarb of 20. pH shows acidemic and according to the Winter's equation the respi... DB's Medical Rants blogs http://www.medworm.com/rss/comments.php?id=3283485 Thu, 18 Feb 2010 02:21:41 +0100 3283485 http://www.medworm.com/index.php?rid=3279930&cid=t_210395_87_f&fid=34469&url=http%3A%2F%2Fwww.medrants.com%2Farchives%2F5298 The patient is a 69 year old woman admitted with abdominal pain and nausea.  She may have lost weight.  She has no known past medical history and is taking no medications.  Her labs give many clues: Electrolyte panel Na 142 Cl 113 BUN 106 K 6.5 HCO3 11 creat 9.1 Blood Sugar 79 Alb 3.2; Calcium 5.1 ABG pH 7.23 pCO2 23 pO2 80 HCO3 10 So please address these questions: 1. What is the acid-base disorder? 2. Predict other laboratory testing? 3. What would you do at admission? Related posts:An acidosis question AMS – an acid-base problem II AMS an acid-base problem – part 1 (Source: DB's Medical Rants) DB's Medical Rants blogs http://www.medworm.com/rss/comments.php?id=3279930 Tue, 16 Feb 2010 19:19:43 +0100 3279930 http://www.medworm.com/index.php?rid=3271162&cid=t_210395_135_f&fid=35274&url=http%3A%2F%2Facidrefluxweb.com%2F%3Fp%3D4346 Even though it’s been a very mild winter, and far more sunny days, it is starting to get a bit more difficult. I haven’t been getting depressed, but I do wake up so bloody tired and stay that way all day.  This is probably due to the fact that I’ve been working hard on a lot of various projects, all of which I enjoy a lot. Then it hits me, what I call “The Wall” I met this guy at the Y, and we had a chat afterwards, and the subject of health comes up.  I have a really hard time answering the question of whether or not I’m in good health or not. I get a lot of colds, and various weird, yet not parlous health problems. The single number one thing for me is my stamina.  I do not have the ability to push myself a great deal. Getting up a few hours early one day and running a lon... acidrefluxweb.com blogs http://www.medworm.com/rss/comments.php?id=3271162 Sun, 14 Feb 2010 15:37:57 +0100 3271162 http://www.medworm.com/index.php?rid=3259117&cid=t_210395_125_f&fid=34820&url=http%3A%2F%2Fwww.dentalblogs.com%2Farchives%2Fadministrator%2Ficon-acid-syringe-for-tooth-preparation%2F No more drill? If you’ve shied away from hard tissue lasers and you hate the mess with air abrasion, but you know that your rotary drill is antiquated, check this out: acid. Yep – now you can prepare teeth for fillings with the same stuff that burned off the face of the Joker…kind of. Acid erosion is blamed for significant oral health concerns these days, but like many things in science, measured and monitored doses of acid can be used for good. The Icon acid syringe for 15-minute fillings with “no pain and no unnecessary loss of healthy hard tissue.” Here’s how it works… First, a rubber barrier is placed around the tooth to be prepared. A small amount of acid gel is injected onto decayed tooth enamel. Over two minutes, the acid etches the tooth’s surface. After heat dryin... dental blog for dentists about dentistry blogs http://www.medworm.com/rss/comments.php?id=3259117 Wed, 10 Feb 2010 14:29:05 +0100 3259117 http://www.medworm.com/index.php?rid=3254136&cid=t_210395_139_f&fid=38879&url=http%3A%2F%2Fwww.virology.ws%2F006_W3310_10.wmv Download: .wmv (324 MB) | .mp4 (76 MB) Visit the virology W3310 home page for a complete list of course resources. (Source: virology blog) virology blog blogs http://www.medworm.com/rss/comments.php?id=3254136 Tue, 09 Feb 2010 16:19:46 +0100 3254136 http://www.medworm.com/index.php?rid=3254655&cid=t_210395_135_f&fid=35274&url=http%3A%2F%2Facidrefluxweb.com%2F%3Fp%3D4342 So far so good for beating severe bouts of depression this winter. Every year for the last several years it seemed to have gotten worse and worse during this cloudy grey and miserable season. Oddly enough, in my hometown of Winnipeg I never had seasonal issues. I can’t think of more of a reason to get depressed about winter than living a three-hour drive north of Fargo with extreme cold leaving one to deal with warnings of exposed skin can freeze within a minute, or less. There is no doubt, winter here in Toronto is a challenge. It was hitting me around Christmas time. I really hate that time of the year. Maybe I should spend the fortune and go back to Winnipeg and spend it with family, as that would at least provide a diversion. The remedy this year has not been tinkering with anti-... acidrefluxweb.com blogs http://www.medworm.com/rss/comments.php?id=3254655 Tue, 09 Feb 2010 14:09:28 +0100 3254655 http://www.medworm.com/index.php?rid=3243982&cid=t_210395_135_f&fid=35274&url=http%3A%2F%2Facidrefluxweb.com%2F%3Fp%3D4332 First there was The Real Housewives of Orange Country, then there was The Real Housewives of New Jersey……Now finally a Canadian spin off….. The Real Hags of Cabbagetown. (Source: acidrefluxweb.com) acidrefluxweb.com blogs http://www.medworm.com/rss/comments.php?id=3243982 Fri, 05 Feb 2010 16:16:14 +0100 3243982 http://www.medworm.com/index.php?rid=3243352&cid=t_210395_139_f&fid=38879&url=http%3A%2F%2Fwww.virology.ws%2F005_W3310_10.mp4 Download: .wmv (386 MB) | .mp4 (131 MB) There are some errors in this lecture – I’ll correct them during the next session. Visit the virology W3310 home page for a complete list of course resources. (Source: virology blog) virology blog blogs http://www.medworm.com/rss/comments.php?id=3243352 Fri, 05 Feb 2010 12:00:41 +0100 3243352 http://www.medworm.com/index.php?rid=3239764&cid=t_210395_135_f&fid=35274&url=http%3A%2F%2Facidrefluxweb.com%2F%3Fp%3D4328 Man oh man things have gotten hectic busy. I can only think of a few time-limited periods of time where I’ve had so much to do. Don’t get me wrong, it’s all good. As grammatically incorrect that is, at least according to my spell check. I mark my tenth year on disability and it’s been a bumpy ride.  I’ve fastened my seat belt and I’m getting ready for an entirely new one. In the past I strived to find the edge of whatever situation that could be risky. That led to doing all sorts of crazy stuff, such as my hooker with a passport days traipsing across the US, and Europe partying, and well, making enough material with which to write a book. During time, especially with all the recovery shit I’m doing, I’ve realized that I am a risk junkie. I like risk. I like to terrify myse... acidrefluxweb.com blogs http://www.medworm.com/rss/comments.php?id=3239764 Thu, 04 Feb 2010 16:01:06 +0100 3239764 http://www.medworm.com/index.php?rid=3223022&cid=t_210395_139_f&fid=38879&url=http%3A%2F%2Fwww.virology.ws%2F003_W3310_10.mp4 Download: .wmv (333 MB) | .mp4 (75 MB) Visit the virology W3310 home page for a complete list of course resources. (Source: virology blog) virology blog blogs http://www.medworm.com/rss/comments.php?id=3223022 Fri, 29 Jan 2010 22:00:18 +0100 3223022 http://www.medworm.com/index.php?rid=3212562&cid=t_210395_135_f&fid=35274&url=http%3A%2F%2Facidrefluxweb.com%2F%3Fp%3D4323 Today I am welcoming the students of the University of South Florida’s online HIV/AIDS course. This post is a welcome, and a little explanation of Acid Reflux. If you click on the menu, “The Cast: Me” there is a short explanation of where I’m coming from. Basically name Acid Reflux originated the vision of Dame Edna during her off-broadway show where she sits down at a table with a couple of people from an audience. She had previously ordered in some food for them, and now they were up on the stage eating their dinners. Dame Edna sits down and starts getting an attack of acid reflux and grabs the napkin of the audience member at the table. This vision hit me considering I wanted to name this blog with 1) a name starting “A” and 2) something that stood ou... acidrefluxweb.com blogs http://www.medworm.com/rss/comments.php?id=3212562 Tue, 26 Jan 2010 18:15:10 +0100 3212562 http://www.medworm.com/index.php?rid=3205073&cid=t_210395_135_f&fid=35274&url=http%3A%2F%2Facidrefluxweb.com%2F%3Fp%3D4320 I’m always hesitant to take on new volunteer activities, as sitting on a couple boards, plus the managing and writing for several websites, I’m feeling pretty busy. Today, though, I received an email from a collaborator of a previous project about blogging as an HIV positive person about an online course where the students are required to create blogs and write about HIV, as part of an HIV/AIDS education program at the University of Central Florida. Our job is to interact with the students, leave comments on the blogs, and chat with them through various structures set up. Lord please help the poor student from across the world who gets me! I’ll be on my best behaviour, and I’ll leave the humour side of me aside for the former educator role. And really this is about establishing rel... acidrefluxweb.com blogs http://www.medworm.com/rss/comments.php?id=3205073 Mon, 25 Jan 2010 15:45:14 +0100 3205073 http://www.medworm.com/index.php?rid=3197840&cid=t_210395_135_f&fid=35274&url=http%3A%2F%2Facidrefluxweb.com%2F%3Fp%3D4317 Oh boy, It’s been a difficult week. And I have to speak to a twelve-step group tonight for the very first time ever. There has been one thing I have learned in recovery is that I now have a new inner intelligence. I wish that intelligence would kick in sooner than later, nonetheless it kicked in, and I had to listen to what it was telling me. This time before proceeding in an irrational way in dealing with a difficult decision I decided to speak to all the “sponsors” I have in my life, not just within a twelve-step program, but outside as well. I have been blessed with having important pivotal relationships in my life. Each of these individuals has been friends and mentors in various aspects of my life. One by one I consulted, and reflected on what was in the best interest of myself ... acidrefluxweb.com blogs http://www.medworm.com/rss/comments.php?id=3197840 Fri, 22 Jan 2010 15:12:36 +0100 3197840 http://www.medworm.com/index.php?rid=3189101&cid=t_210395_87_f&fid=34469&url=http%3A%2F%2Fwww.medrants.com%2Farchives%2F5211 This article makes one think differently.  I like articles that challenge common wisdom. Is Metformin Associated With Lactic Acidosis? It appears that metformin itself may not increase the risk for lactic acidosis. And although metformin use has increased over the years, the incidence of lactic acidosis has not increased. Additionally, there is no evidence to suggest that sulfonylureas alone increase the risk for lactic acidosis. Rather, the presence of underlying conditions and concomitant use of other medications may elevate an individual's risk level. Some suggest that diabetes mellitus, rather than specific antidiabetes medications, may predispose a patient to lactic acidosis. The mechanisms for this increased risk are unknown. In practice, it may be important to consider d... DB's Medical Rants blogs http://www.medworm.com/rss/comments.php?id=3189101 Wed, 20 Jan 2010 10:48:34 +0100 3189101 http://www.medworm.com/index.php?rid=3189346&cid=t_210395_135_f&fid=35274&url=http%3A%2F%2Facidrefluxweb.com%2F%3Fp%3D4313 It’s been such a struggle over the past little while. If I were to do a Step 4, writing out and inventory, and then Step 5, (actually share what my inventory with another), there would be tomes of paragraphs, so much so that there would be on continuous page stretched out all the way from my couch all the way to the Great Wall of China. If I had a wish list for this last week, I would have wished: To have been a better communicator, To not be such an emotional mess at times, To have not started smoking under duress (but watch me quite of PositiveLite.com – I started the quitting challenge by starting. My lungs are starting to feel it, and for sure a quit date will be set soon.) To not be so scared sometimes, To have an appetite – maybe that’s related to the smoking,... acidrefluxweb.com blogs http://www.medworm.com/rss/comments.php?id=3189346 Wed, 20 Jan 2010 03:08:37 +0100 3189346 http://www.medworm.com/index.php?rid=3182333&cid=t_210395_135_f&fid=35274&url=http%3A%2F%2Facidrefluxweb.com%2F%3Fp%3D4308 I’m back to using Acid Reflux as my diary as I’ve sorted out what content goes where. Yesterday I was feeling increasing yuckier. Today is much better. I headed out to my Sunday routine of a meeting, and instead of my standard brunch afterwards I had a date. Well, there’s nothing like a little Tim Horton’s “Roll up the rim to win“, if one were to change the verb tense into a gerund, to perk up ones spirits. This time I made sure that I hadn’t accidentally left any used condoms on the night table ” it’s amazing how I suddenly stopped seeing that sucker laying there until that one date left” and the pillow cases were all washed, so no goober marks all over them. I know, it sounds like I’m getting laid all the time. Sadly that ... acidrefluxweb.com blogs http://www.medworm.com/rss/comments.php?id=3182333 Mon, 18 Jan 2010 03:55:52 +0100 3182333 http://www.medworm.com/index.php?rid=3180381&cid=t_210395_135_f&fid=35274&url=http%3A%2F%2Facidrefluxweb.com%2F%3Fp%3D4302 It’s Saturday night, and The Real Housewives of Atlanta is on.  Last week was the first time I watched it, and well, I’m hooked. It’s not as interesting as the housewives of NJ. Let’s face it; it’s hard to compete with Jersey Italians. So I sit here contemplating the fact that I picked up a “desire chip” at one of my AA meetings. I never pick those up. For those not in the know, it is a chip people will pick up if they are just arriving, or just want to recommit to the program. Today I needed to recommit.  Three-years into this recovery stuff, and last night I have the most hardcore vivid dream of going out and getting completely wasted. Then I had gone back to a meeting and let people know that I had gone out and relapse. It was all so real. So real in fact I had to take a... acidrefluxweb.com blogs http://www.medworm.com/rss/comments.php?id=3180381 Sun, 17 Jan 2010 02:27:55 +0100 3180381 http://www.medworm.com/index.php?rid=3167353&cid=t_210395_135_f&fid=35274&url=http%3A%2F%2Facidrefluxweb.com%2F%3Fp%3D4296 From time to time I am reminded why I say I am in recovery. It’s not an easy thing to say. It’s like saying I have AIDS. There’s a baggage with these two words and what they represent. All sorts of stereotypical images are conjured up. Ironically enough, these two words at times can conjure up similar images. Just shy of three years of this round of sobriety (I had a year and a bit prior to this time……which is another story that includes Sustiva, injection needles (for HIV meds and my arms) Puerto Vallarta, and being crown Miss Don Woods 2007 – a Toronto rehab facility. That was then, this is today. Yet, still, there is voice in my head that tells me that really, I’m not like those other folks I see sitting in these twelve-step rooms.  Now, there ... acidrefluxweb.com blogs http://www.medworm.com/rss/comments.php?id=3167353 Wed, 13 Jan 2010 15:07:27 +0100 3167353 http://www.medworm.com/index.php?rid=3164001&cid=t_210395_135_f&fid=35274&url=http%3A%2F%2Facidrefluxweb.com%2F%3Fp%3D4294 Getting the YMCA is always a struggle for me. Once I’m out the door and committed to it, I find it not so bad. Then the little surprises happen that make me even happier that I’ve gone. First off the bat, I see the one guy who’ve I’ve ever successfully cruised and met at the Y. He is so my type (and I have many) – short, shaved head, very tight muscular body, and an ass of a dancer.” I see him and walk over, he’s completely naked slapping on his moisturizer. Good thing I was dressed, cause he’s one of the few people I feel like this animal instinct taking over of just wanting to start going at it in the middle of the change room. With a few guys around us, I wouldn’t wanted to started to have gotten a hard on. As he was leaving, and in my underwear, he came over and his h... acidrefluxweb.com blogs http://www.medworm.com/rss/comments.php?id=3164001 Tue, 12 Jan 2010 14:42:08 +0100 3164001 http://www.medworm.com/index.php?rid=3142782&cid=t_210395_135_f&fid=35274&url=http%3A%2F%2Facidrefluxweb.com%2F%3Fp%3D4284 So far in the new years, the only thing that has happened is that I’m freezing my balls off. Today is better than the last couple of days. I live on the top floor corner unit and the building’s roof is being redone. With the insulation pulled off, the first day of real winter arrives and my place turns into a refrigeration unit, thus forcing me to engage in a Canadian cultural experience by having to head down to Canadian Tire. Even with the heater, when the temperature drops, I’ve resorted to turning on the oven with the door cranked open, and letting my dryer run a bit. Hopefully it won’t take long for them to get this work done, and Mother Nature will give us a break with some nice weather. The big question for me for this new year is: Will I actually let someone... acidrefluxweb.com blogs http://www.medworm.com/rss/comments.php?id=3142782 Mon, 04 Jan 2010 20:38:28 +0100 3142782 http://www.medworm.com/index.php?rid=3129651&cid=t_210395_135_f&fid=35274&url=http%3A%2F%2Facidrefluxweb.com%2F%3Fp%3D4226 The holidays are almost over, and this is one for the only times I evoke the lord and baby jesus’ (note that I refuse to capitalize any of those nouns and proper names as an act of religious rebellion – and I’m not christian, I unbaptimized myself long time at as a form of being unborn instead of reborn), so with that in mind a big “thank christ” the holidays are  almost over! I know I can’t go wrong on New Year’s Eve with Anderson Cooper and Kathy Griffin. I love watching Anderson giggle at inside gay jokes and references in a way as to not really acknowledge that he’s into big muscled Latino cock. The annual ritual of sliding into a wintertime depression hit me. It was the perfect storm of my immune system down fighting off some cold, fatigue, the holidays, the g... acidrefluxweb.com blogs http://www.medworm.com/rss/comments.php?id=3129651 Wed, 30 Dec 2009 16:10:23 +0100 3129651 http://www.medworm.com/index.php?rid=3105240&cid=t_210395_135_f&fid=35274&url=http%3A%2F%2Facidrefluxweb.com%2F%3Fp%3D4222 I’d thank Christ for Christmas for being almost over but I’m not a Christian, and Jesus is long dead. Instead I should really thank the Pagans for the winter solstice almost being over, since it was the Christians who co-opted the holiday in order to make it easier to convert or impose this new religion. As always, there’s a Madonna quote to fit every occasion and that is from American Life: I’m not a Christian, and I’m not a Jew. I was baptized at the United Church – no wonder I turned out gay with their libertarian ways – in Winnipeg many a year ago. None of my family was, or is particularly religious. My grandmother tended to go to church and be involved, but never invoked the images of hell when my lesbian second cousin got married and then stayed with her. Nonetheless, m... acidrefluxweb.com blogs http://www.medworm.com/rss/comments.php?id=3105240 Sat, 19 Dec 2009 15:30:50 +0100 3105240 http://www.medworm.com/index.php?rid=3100741&cid=t_210395_87_f&fid=34469&url=http%3A%2F%2Fwww.medrants.com%2Farchives%2F5108 I ordered a renal consult for our patient, thinking that his kidney disease might be the cause of the anemia.  The renal team decided to try iron once again, and then consider a trial of erythropoeitin as an outpatient if he does not respond to iron. I thought he might have significant diabetic renal disease, so we did a urine protein/creatinine ratio, but it was quite low.  He probably should be taking an ACE inhibitor – again he has good followup in renal clinic. By the afternoon we had 6 admissions.  We had an interesting question for you to ponder. Patient transferred from the ICU.  Patient apparently has persistent ascending cholangitis with accompanying persistent lactic acidosis.  The bicarbonate is 18.  So the question is whether to give bicarbon... DB's Medical Rants blogs http://www.medworm.com/rss/comments.php?id=3100741 Fri, 18 Dec 2009 11:24:55 +0100 3100741 http://www.medworm.com/index.php?rid=3096800&cid=t_210395_87_f&fid=34469&url=http%3A%2F%2Fwww.medrants.com%2Farchives%2F5102 Yesterday I provided this patient: Interesting patient presented recently.  He is HIV+ and has a 10 day history of large volume watery diarrhea. On the 3rd day his BMP showed.  On admission his HCO3 was 19. Electrolyte panel Na 149 Cl 128 BUN 13 K 3.0 HCO3 12 creat 0.8 This is actually relatively easy. 1. What is the likely acid-base problem? Given the large volume watery diarrhea, he likely has stool losses of bicarbonate. 2. How can we prove our assumption? We obtained an ABG and a urine anion gap. ABG: pH 7.2; pCO2 23; pO2 125; HCO3 9 Una 58; Uk 11; Ucl 156 – for Urine Anion Gap of -87.  This is a profound negative anion gap and confirms our suspected diagnosis. 3. How would you treat this patient? We considered 3 issues in treatment: Hypernatremia &#8... DB's Medical Rants blogs http://www.medworm.com/rss/comments.php?id=3096800 Thu, 17 Dec 2009 13:25:18 +0100 3096800 http://www.medworm.com/index.php?rid=3092652&cid=t_210395_87_f&fid=34469&url=http%3A%2F%2Fwww.medrants.com%2Farchives%2F5097 Interesting patient presented recently.  He is HIV+ and has a 10 day history of large volume watery diarrhea. On the 3rd day his BMP showed.  On admission his HCO3 was 19. Electrolyte panel Na 149 Cl 128 BUN 13 K 3.0 HCO3 12 creat 0.8 This is actually relatively easy. 1. What is the likely acid-base problem? 2. How can we prove our assumption? 3. How would you treat this patient? Related posts:An acidosis questionAnother hyperkalemia – whyMy answer to intubated (Source: DB's Medical Rants) DB's Medical Rants blogs http://www.medworm.com/rss/comments.php?id=3092652 Wed, 16 Dec 2009 13:35:13 +0100 3092652 http://www.medworm.com/index.php?rid=3089495&cid=t_210395_135_f&fid=35274&url=http%3A%2F%2Facidrefluxweb.com%2F%3Fp%3D4214 Here is an example of some to the stuff I post on PositiveLite.com Today I have to do the one thing I haven’t been looking forward to: having to get up and recite David Sedaris is a group setting. I just keep telling myself, we’ll all just students, so let’s just have fun with it and not worry about. I warned Christine (the coach) that she was going to make me cry, and I was going to tell everyone about it. But that seemed so far away at the time, and here we are today. Time has been flying by. Last week I reconnected with a friend who has re-entered politics, Glen Murray. We first met way back in the 80s in Winnipeg when Canada Post transferred him. Over time we had become friends, and he was the around at the Village Clinic the night that I got my test results back in ... acidrefluxweb.com blogs http://www.medworm.com/rss/comments.php?id=3089495 Tue, 15 Dec 2009 13:48:26 +0100 3089495 http://www.medworm.com/index.php?rid=3082990&cid=t_210395_139_f&fid=38879&url=http%3A%2F%2Fmedia.rawvoice.com%2Fpmn_twiv%2Fwww.twiv.tv%2FTWiV062.mp3 Hosts: Vincent Racaniello, Dickson Despommier, and Alan Dove On episode #62 of the podcast This Week in Virology, Vincent, Dickson, and Alan discuss STEP HIV-1 vaccine failure caused by the adenovirus vector, presence of West Nile virus in kidneys for years after initial infection, adaptation of the influenza viral RNA polymerase for replication in human cells, and the significance of the D225G change in the influenza HA protein. Download TWiV #62 (47 MB .mp3, 66 minutes) Subscribe to TWiV (free) in iTunes , at the Zune Marketplace, by the RSS feed, or by email. Links for this episode: HIV vaccine failure probably caused by adenovirus vector used Persistence of West Nile virus in kidneys for years (JID and ProMedMail) (thanks, Lenn!) Adaptive strategies of influenza RNA polymerase for rep... virology blog blogs http://www.medworm.com/rss/comments.php?id=3082990 Sun, 13 Dec 2009 14:20:58 +0100 3082990 http://www.medworm.com/index.php?rid=3063431&cid=t_210395_135_f&fid=35274&url=http%3A%2F%2Facidrefluxweb.com%2F%3Fp%3D4211 When I first moved to Toronto, I was hired as one of the speaker’s bureau for The Toronto PWA Foundation. Suddenly I went from speaking to small comfortable groups (up to 50) to as many as 800 or more in a school auditorium. I absolutely hated it. Microphones scared me as I heard my voice echo back at me. Trying to find some kind of personal connection as I looked upon a sea of faces while I spoke about the most intimate details of my life to strangers was challenging at best. Even if someone I knew had died the night before, I’d still have to get up there and do it. It was hard as a kid who grew up with the constant mocking over the way I spoke. I learned that my voice was bad, and by extension I was bad. I was not to be heard. To not be heard was to be invisible. My self-esteem was s... acidrefluxweb.com blogs http://www.medworm.com/rss/comments.php?id=3063431 Mon, 07 Dec 2009 14:48:04 +0100 3063431 http://www.medworm.com/index.php?rid=3048307&cid=t_210395_135_f&fid=35274&url=http%3A%2F%2Facidrefluxweb.com%2F%3Fp%3D4206 I kicked off the spirit with my post “F. a Poz Guy” for World AIDS Day. The video version is here, and the written version on GayGuideToronto.Com, which is a little different is here. The video version is like getting the DVD, there are a couple little extras. Yesterday was such a big day for us. Even though we said December 1st was our launch date, it was a bit like playing semantics. A date needed to be chosen, however we’d been up and working at it for quite sometime. There was no sudden appearance of a site that was not there before. The morning, Brandon and I headed off to what I call the annual “Cursing of Louise” event. My dear friend’s World AIDS Day Breakfast fundraiser at 8 am. It’s very much like going to the gym, I go kicking and scream... acidrefluxweb.com blogs http://www.medworm.com/rss/comments.php?id=3048307 Wed, 02 Dec 2009 16:53:49 +0100 3048307 http://www.medworm.com/index.php?rid=3044691&cid=t_210395_87_f&fid=34469&url=http%3A%2F%2Fwww.medrants.com%2Farchives%2F5057 55 yo man with SC disease and membranous nephritis.  He is taking an ACE inhibitor to decrease his urine protein and delay progression of renal disease.  We saw these labs Electrolyte panel Na 133 Cl 107 BUN 27 K 5.1 HCO3 19 creat 1.2 This was the last day of my tour at the VA.  So instead of making this a puzzle, I will tell you what we did.  You can consider your options before you read what follows:     Serum osms 283 Urine osms 351 Urine Na 101 Urine K 13 Urine Cl- 96 We did not obtain an ABG because we felt the diagnosis was crystal clear. TTKG   was low at 2.1 confirming low aldosterone effect Urine anion gap was positive +18 confirming renal acidosis ACTH stim test was normal   So we made a diagnosis of type IV RTA.  We con... DB's Medical Rants blogs http://www.medworm.com/rss/comments.php?id=3044691 Tue, 01 Dec 2009 15:23:22 +0100 3044691 http://www.medworm.com/index.php?rid=3044307&cid=t_210395_139_f&fid=38879&url=http%3A%2F%2Fmedia.rawvoice.com%2Fpmn_twiv%2Fwww.twiv.tv%2FTWiV060video.wmv Hosts: Vincent Racaniello and Dickson Despommier Vincent and Dick continue Virology 101 with a discussion of how RNA viruses produce mRNA and replicate their genomes. Download TWiV #60 (51 MB .mp3, 71 minutes) Subscribe to TWiV in iTunes, by the RSS feed, or by email Links for this episode: Diagrams of viral RNA synthesis Animations of influenza virus and HIV-1 replication Video for this episode – see below Weekly Science Picks Dick The Double Helix by James D. Watson Vincent Worms and Germs Blog Send your virology questions and comments (email or mp3 file) to twiv@twiv.tv or leave voicemail at Skype: twivpodcast. You can also send articles that you would like us to discuss to delicious and tag them with to:twivpodcast. Below is a video of TWiV 60, which highlights the diagrams I r... virology blog blogs http://www.medworm.com/rss/comments.php?id=3044307 Sun, 29 Nov 2009 16:30:17 +0100 3044307 http://www.medworm.com/index.php?rid=3037067&cid=t_210395_135_f&fid=35274&url=http%3A%2F%2Facidrefluxweb.com%2F%3Fp%3D4203 Back do to popular demand. Ok, well maybe not popular but one person did ask. I haven’t done a Hildy Came for a while. So here is Hildy Go Fetch for a nice Sunday morning. (Source: acidrefluxweb.com) acidrefluxweb.com blogs http://www.medworm.com/rss/comments.php?id=3037067 Sun, 29 Nov 2009 15:34:06 +0100 3037067 http://www.medworm.com/index.php?rid=3029774&cid=t_210395_87_f&fid=34469&url=http%3A%2F%2Fwww.medrants.com%2Farchives%2F5026   Electrolyte panel Na 132 Cl 85 BUN 73 K 2.8 HCO3 37 creat 2.8 Blood Sugar 205 Seeing this BMP yesterday showed the difference between knowledge and wisdom.  For experienced clinicians, the patterns in this BMP are obvious.  For many students and interns, we just have 7 numbers. Here is how I think through this problem: The patient has an elevated creatinine and BUN. The BUN is much more elevated than the creatinine (greater than 20:1), therefore I suspect either GI bleed or significant volume contraction.  I know that the patient has a stable Hgb and heme negative stool, so I strongly suspect volume contraction. The HCO3 is markedly elevated, supporting either metabolic alkalosis or compensation for respiratory acidosis.  The patient has no history o... DB's Medical Rants blogs http://www.medworm.com/rss/comments.php?id=3029774 Thu, 26 Nov 2009 12:24:17 +0100 3029774 http://www.medworm.com/index.php?rid=3029775&cid=t_210395_87_f&fid=34469&url=http%3A%2F%2Fwww.medrants.com%2Farchives%2F5024 Day 11 involved discussing 5 new patients, and continuing plans on the remaining patients. One patient brought out some important teaching points.  The patient is in his 70s and came in for weakness.  His routine labs made the diagnosis:   Electrolyte panel Na 132 Cl 85 BUN 73 K 2.8 HCO3 37 creat 2.8 Blood Sugar 205   Two months ago his values were:   Electrolyte panel Na 137 Cl 103 BUN 18 K 3.4 HCO3 27 creat 1 Blood Sugar 144   While I think this is an easy one, the students and interns did not yet have the lab interpretation instincts.  So I will ask my readers to provide the explanation.  I will give my thoughts tomorrow. Related posts:17 days at the VA – Day 8Another hyperkalemia – my explanationAn acidosis q... DB's Medical Rants blogs http://www.medworm.com/rss/comments.php?id=3029775 Wed, 25 Nov 2009 17:58:23 +0100 3029775 http://www.medworm.com/index.php?rid=3022728&cid=t_210395_139_f&fid=38879&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FVirologyBlog%2F%7E3%2FR2_2kJHRwx0%2F The Norwegian Institute of Public Health recently identified a mutation in 2009 H1N1 influenza virus isolated from two patients who died and one with severe disease. It has been suggested that this mutation, which causes a change from the amino acid aspartic acid to glycine at position 225 of the viral HA protein (D225G), could make the virus more likely to infect deeper in the airways and cause more severe disease. What is the basis for this concern and does it have merit? Attachment of all influenza A virus strains to cells requires sialic acids. There are a number of chemically different forms of sialic acids, and influenza virus strains vary in their affinity for them. Human influenza A strains bind preferentially to sialic acids linked to galactose by an alpha(2,6) bond, while avian a... virology blog blogs http://www.medworm.com/rss/comments.php?id=3022728 Tue, 24 Nov 2009 16:57:49 +0100 3022728 http://www.medworm.com/index.php?rid=3023372&cid=t_210395_135_f&fid=35274&url=http%3A%2F%2Facidrefluxweb.com%2F%3Fp%3D4201 Oh and I have to post this. I actually saw this when it was first air on TV. I really only know these guys because The Soup makes soooo much fun of them. And just when you think you couldn’t hate the no-talent stars of the insanely juvenile ”The Hills” any more, you can. Just watch! Here is my GayGuideToronto.Com update where I give you TMI-rated Facebook this week. I’ve been so singularly obsessed over this www.positivelite.com project. So much so that I can’t even rememer the last time I jerked off? Was the last time I came when I had that John Waters moment with the used comdon still on the end table for the last guy when I was doing someone else? Yap, you know it’s bad when you can’t figure out that one! We need more people on the FaceBook Pa... acidrefluxweb.com blogs http://www.medworm.com/rss/comments.php?id=3023372 Tue, 24 Nov 2009 16:47:51 +0100 3023372 http://www.medworm.com/index.php?rid=3019200&cid=t_210395_135_f&fid=35274&url=http%3A%2F%2Facidrefluxweb.com%2F%3Fp%3D4189 I admit it. I can only obsess over one thing at a time. And with the launching of PositiveLite.com means all my focus has been going there as we are going viral on world aids day, the one holy HIV day of the year. It’s the day we run people who are actually living this virus into the ground by having to attend a million events during and around that day. Plus we’re usually the people propped up for the media/panels/events to send out our annual message. I consider it like the Queen’s one address to her subjects for the year. My annual “She’s Still Here 2009 Tour” is looking to be a small one.  This is the one thing that coincides with Dec. 1st. I pop up in the media (this year it may only be Proud FM) to let everyone know that “She’s still h... acidrefluxweb.com blogs http://www.medworm.com/rss/comments.php?id=3019200 Mon, 23 Nov 2009 14:01:43 +0100 3019200 http://www.medworm.com/index.php?rid=3018960&cid=t_210395_87_f&fid=34469&url=http%3A%2F%2Fwww.medrants.com%2Farchives%2F5014 Relatively easy day – just the resident, 1 intern and me rounding on 6 patients.  We had an interesting acid-base puzzle.  The patient is in his 50s and has known hep C positivity (possible cirrhosis) and recent nephrotic syndrome.  How do you dissect information just from his electrolyte panel.  One other hint – his albumin is 2.2.   Electrolyte panel Na 141 Cl 108 BUN 67 K 4.1 HCO3 18 creat 7.9 Blood Sugar 90       Related posts:Another hyperkalemia – my explanationPart 2 of the acid-base problemA 2 part acid-base problem (Source: DB's Medical Rants) DB's Medical Rants blogs http://www.medworm.com/rss/comments.php?id=3018960 Sun, 22 Nov 2009 16:43:28 +0100 3018960 http://www.medworm.com/index.php?rid=3012342&cid=t_210395_87_f&fid=34469&url=http%3A%2F%2Fwww.medrants.com%2Farchives%2F5006 Day 6 we admit again.  When I left yesterday we had 4 patients already. Rounds yesterday focused mostly on teaching.  As an attending, I make a 2 hour commitment to my teams.  They get me for 2 hours and I get them for 2 hours, regardless.  Yesterday we reviewed my favorite diabetes mneumonic – the FLECKS.  After that we focused on a problem from day 4. On day 4 we had a patient who needed a BKA.  This day my resident had off, so I functioned as a res-attending.  Fortunately, at the VA we have an excellent EMR.  After making rounds, I sit down to do my notes in the team room. My notes have a template that allows me to review the medications and the labs.  I quickly peruse both to be careful.  In so doing, I noticed that the patient... DB's Medical Rants blogs http://www.medworm.com/rss/comments.php?id=3012342 Fri, 20 Nov 2009 11:43:17 +0100 3012342 http://www.medworm.com/index.php?rid=3008358&cid=t_210395_135_f&fid=35274&url=http%3A%2F%2Facidrefluxweb.com%2F%3Fp%3D4185 It seemed like a day where a video is more in order to share with everyone what my Hag Wednesday is like, and my little John Water’s like tales of how I do “Kink on a Dime.” (Source: acidrefluxweb.com) acidrefluxweb.com blogs http://www.medworm.com/rss/comments.php?id=3008358 Thu, 19 Nov 2009 13:46:56 +0100 3008358 http://www.medworm.com/index.php?rid=2999761&cid=t_210395_135_f&fid=35274&url=http%3A%2F%2Facidrefluxweb.com%2F%3Fp%3D4183 Pet Peeve of the week: Public washrooms! While at the OHTN conference at The Hilton and there is nothing worse than sitting in a full run of stalls full of colleagues shitting themselves and I’m about to as well. As outgoing as I may be, I draw the line of sharing my shitting sounds and smells with an entire room, and I certainly take an exception of having to sniff the odorous whiffs and bursting sounds. I’m about to embark on Day Two of the conference. If there is a baby jesus out there, please don’t like me have to sit beside anyone having to empty their bowels. (Source: acidrefluxweb.com) acidrefluxweb.com blogs http://www.medworm.com/rss/comments.php?id=2999761 Tue, 17 Nov 2009 15:10:25 +0100 2999761 http://www.medworm.com/index.php?rid=2999475&cid=t_210395_87_f&fid=34469&url=http%3A%2F%2Fwww.medrants.com%2Farchives%2F4996 My team had a relatively easy Sunday call day.  On post call days, we spend 3 hours presenting new patients, discussing old patients and seeing all the patients.  I told me team on Sunday that I would use the entire time regardless.  With only 3 new patients, we had leisurely, and I hope educational, discussions of each patient. One patient in particular presented an interesting issue – why saline can make hyponatremia worse?  Our patient presented with a sodium level of 125.  His serum osms were 249. He is euvolemic.  Prior to receiving the urine osm report, we started IV saline – giving approximately 1.3 liters.  Then the urine osms were approximately 630. For those who already understand this phenomenon, you might predict that the sodium wo... DB's Medical Rants blogs http://www.medworm.com/rss/comments.php?id=2999475 Tue, 17 Nov 2009 12:20:50 +0100 2999475 http://www.medworm.com/index.php?rid=2993737&cid=t_210395_87_f&fid=34469&url=http%3A%2F%2Fwww.medrants.com%2Farchives%2F4987 This is a classic ABG sequence: ABG Admission (on 2 L O2) Day 2 (Bipap 100%) ABGs on successive days pH 7.28 7.52 pCO2 89 52 pO2 60 373 HCO3 42 42               Your tasks are to understand and explain the course of events for this woman having a COPD exacerbation.   1. What is the initial acid-base disorder? The patient has a chronic respiratory acidosis with metabolic compensation.  I cannot remember the calculations, so I found a calculator online.   2. What is the second day disorder? This disorder goes by the name post-hypercapnic metabolic alkalosis.  I sometimes use the phrase "revealed metabolic alkalosis".  It occurred because the patient had an appropriate compensation for a chronic respirator... DB's Medical Rants blogs http://www.medworm.com/rss/comments.php?id=2993737 Sun, 15 Nov 2009 13:56:34 +0100 2993737 http://www.medworm.com/index.php?rid=2989112&cid=t_210395_87_f&fid=34469&url=http%3A%2F%2Fwww.medrants.com%2Farchives%2F4983 This is a classic ABG sequence: ABG Admission (on 2 L O2) Day 2 (Bipap 100%) ABGs on successive days pH 7.28 7.52 pCO2 89 52 pO2 60 373 HCO3 42 42               Your tasks are to understand and explain the course of events for this woman having a COPD exacerbation.   1. What is the initial acid-base disorder? 2. What is the second day disorder? 3. What would you do now? Related posts:Intubated and difficult to weanMy answer to intubatedAn acidosis question (Source: DB's Medical Rants) DB's Medical Rants blogs http://www.medworm.com/rss/comments.php?id=2989112 Fri, 13 Nov 2009 13:05:17 +0100 2989112 http://www.medworm.com/index.php?rid=2984981&cid=t_210395_135_f&fid=35274&url=http%3A%2F%2Facidrefluxweb.com%2F%3Fp%3D4180 The old H1N1 vaccine/cold combo obliterated my productivity last week. When they say don’t get with a cold, there is a very good reason for it. Over the course of the past few weeks, it seems like there has been this onslaught of people I know getting sick, or worse dying. Yesterday I heard news of yet someone else whose last message on Facebook was something to the effect of having either a cold or flu and was going to take some over the counter meds and sleep it off. It was a sleep he never woke up from. My sponsor has been in the hospital struggling, but thankfully getting better. Friends close ones have been dying, and it just goes on and on. A while back a friend and I were having a chat, and we both thought we were going to see another wave of deaths. And here we are, but not t... acidrefluxweb.com blogs http://www.medworm.com/rss/comments.php?id=2984981 Thu, 12 Nov 2009 15:01:18 +0100 2984981 http://www.medworm.com/index.php?rid=2967483&cid=t_210395_135_f&fid=35274&url=http%3A%2F%2Facidrefluxweb.com%2F%3Fp%3D4175 If you want my advice, don’t take the H1N1 shot when you have a mild cold, unless you are extermely concerned about the porc flu due to underlying conditions. Taking it while under the weather has turned something very milded into a weird cold-  & flu-like illess since last tuesday. I did manage to put together some video that I’d been meaning to edit on the first five of the top ten reasons why I need to get laid. The video format is a work in progress for me. To see it, you have to go here (Source: acidrefluxweb.com) acidrefluxweb.com blogs http://www.medworm.com/rss/comments.php?id=2967483 Fri, 06 Nov 2009 16:09:27 +0100 2967483