Morning Sniffles » Health and Fitness

A rare heart condition

morning sniffles — Fri, 25 Nov 2011 13:32:05 +0000

This is a case of a 41-year-old male who came in for right atrial mass excision.
During his annual physical exam there was a noted mass in the right atrium of his heart and was advised to undergo surgery.
According to adam.com: A myxoma is a benign tumor in the heart. Right atrial myxomas occur less frequently than left atrial myxomas. Treatment is necessary to avoid metastasis and the formation of clots. In addition, untreated growth of the tumor can obstruct blood flow through the heart. Myxomas are curable with surgical removal.
During the endorsement from the Surgical ICU I was told that the patient’s case was taunted as one in a million as the most common site for myxoma is the left atrium. Checking on line at MedlinePlus, it says that about 75% of myxomas occur in the left atrium of the heart, usually beginning in the wall that divides the two upper chambers of the heart. The rest are in the right atrium. Right atrial myxomas are sometimes associated with tricuspid stenosis and atrial fibrillation.
Myxomas are more common in women. About 10% of myxomas are passed down through families (inherited). Such tumors are called familial myxomas. They tend to occur in more than one part of the heart at a time, and often cause symptoms at a younger age than other myxomas.
He presented with no symptoms as right atrial myxomas rarely produce symptoms until they have grown to be at least 13 cm (about 5 inches) wide. Common symptoms of such as disease are the following:
• Breathing difficulty when lying flat
• Breathing difficulty when asleep
• Chest pain or tightness
• Dizziness
• Fainting
• Sensation of feeling your heart beat (palpitations)
• Shortness of breath with activity

The operation which was done on his second hospitalization day was successful. Also, the biopsy performed on the excised mass turned out to be benign and non-cancerous. He continued to have normal vital signs and he was discharged the day before his birthday.

Peritoneal Dialysis versus Hemodialysis

morning sniffles — Mon, 14 Nov 2011 14:58:42 +0000

This is a case of 56 year-old-female who was diagnosed to have diabetes mellitus for 38 years. Her uncontrolled diabetes has taken its toll on his other systems such as the urinary and cardiac systems. She has just underwent Coronary Artery Bypass Graft to treat her 3-vessel disease. Before that, she was diagnosed to have Chronic Kidney Disease secondary to Nephropathy and has not been urinating normally for years (anuric). She has been created with arteriovenous fistula (AVF) on her left antecubital area for hemodialysis about 1 ½ months ago. Right now she is on peritoneal dialysis for three years with her own dialyzer machine. Her caregiver is doing the peritoneal dialysis for her with the order she got directly from her nephrologist.
So what is the difference between peritoneal dialysis (PD) and hemodialysis (HD)?
Dialysis is the process of removing waste products and water from the bloodstream. Necessary elements include a semipermeable membrane, dialysate solution, and a surgically created access. Blood is separated from dialysate solution by a semipermeable membrane. Because the dialysate solution contains physiologic amounts of electrolytes and buffers, exposure to blood across the membrane allows diffusion to begin. Solutes dissolved in the blood, such as blood urea nitrogen (BUN) and creatinine, cross the membrane from an area of greater to an area of lesser concentration. Osmosis is the other process at work, whereby water moves across the membrane into the dialysate, which by virtue of its composition has a lesser concentration of water molecules. (Levy, Morgan, & Brown, 2001). Both HD and PD rely on these basic principles of osmosis and diffusion.
During hemodialysis, the blood is pumped into a machine to be filtered and then returned to the body. On the other hand, PD process include the infusion time, dwelling time and the drain time.
In PD, a soft tube called a catheter is used to fill the abdomen with a cleansing liquid called dialysis solution. The walls of the abdominal cavity are lined with a membrane called the peritoneum, which allows waste products and extra fluid to pass from the blood into the dialysis solution. The solution contains a sugar called dextrose that will pull wastes and extra fluid into the abdominal cavity. These wastes and fluid then leave the body when the dialysis solution is drained. The used solution, containing wastes and extra fluid, is then thrown away. The process of draining and filling is called an exchange and takes about 30 to 40 minutes. The period the dialysis solution is in the abdomen is called the dwell time. A typical schedule calls for four exchanges a day, each with a dwell time of 4 to 6 hours. Different types of PD have different schedules of daily exchanges.
Patients who are ambulatory, work, want independence, live a distance from the nearest dialysis unit, like to travel, and like to participate in their care are apt to choose PD. Often, patients who are severely limited in mobility or who live in a nursing home will opt for PD because someone else is available to perform the therapy. Medical reasons to use PD include failed vascular accesses and severely compromised cardiac function.
A particular advantage of PD is that because of its continuous nature, potassium is not nearly as restricted in the diet as it is on HD, nor is fluid. In fact, it is not uncommon to find hypokalemia and dehydration in certain PD patients.
In HD, a nurse or a technician cares for the patient during treatment. The PD patient performs self-care, with the support and encouragement of the PD team. (Source: Findarticles.com)
One of the biggest adjustments you must make when you start hemodialysis treatments is following a strict schedule. Most patients go to a clinic-a dialysis center-three times a week for 3 to 5 or more hours each visit.
One important step before starting hemodialysis is preparing a vascular access, a site on your body from which your blood is removed and returned. A vascular access should be prepared weeks or months before you start dialysis. It will allow easier and more efficient removal and replacement of your blood with fewer complications. (Source: National Kidney & Urologic Diseases Information Clearinghouse (NKUDIC))
In a nutshell, the PD can be performed anywhere by a person who was taught to perform it while HD is done in dialysis centers performed by a dialysis nurse or any trainged healthcare personnel.

A new hope

morning sniffles — Tue, 18 Oct 2011 15:21:21 +0000

This is a case of a 45-year old female who was referred by another hospital on her island with chief complaint of body weakness and pain while urinating or dysuria.
She was diagnosed with cervical cancer stage IIA with vaginal extension in a local hospital on her island. PAP smear in May 2010 showed HGSIL/CIS or High grade squamous intraepithelial lesion, or HGSIL for short, is a medical term given to a category of cervical dysplasia detected through a Pap smear. Cervical dysplasia is mild to severe abnormal changes that can occur in the lining of the cervix. Her biopsy then showed poorly differentiated squamous cell carcinoma.
A Pap smear is a test used to detect cervical cancer or abnormal changes in the cervical cell. It is done by taking sample of cells by the use of a small spatula.The cells are then placed in a tube with a preservative, or placed on a slide and sent to laboratory to tests.
If HGSIL is found through a Pap smear, a colposcopy is then done to confirm results. A colposcopy is an in-office procedure that allows a doctor to examine the cervix more in-depth. It is done by using a colposcope, a lighted microscope that magnifies the cervix.
Since we do not have that type of equipment, the patient procedure was done in another hospital.

During the colposcopy, the doctor may also do a cervical biopsy, the removal of small pieces of cervical tissue. The tissue samples are then sent to a lab for further examination.
Due to lack of resources in her place then, colposcopy was never performed. The OB –Gyne to whom she was referred to immediately requested for such.

A colposcopy is performed in the doctor’s office and normally takes less than an hour to perform. Results are available within two weeks, depending on the lab the doctor uses.
It was actually my first encounter with the OB-Gyne from another hospital and I was really impressed by his ability to show genuine concern with the patient who hardly understand English and took her time discussing the matter with the patient’s niece. I have learned from him that the patient’s condition is not actually cervical cancer but as he termed “pre-cancer”.
Although there are other procedures done to destroy the abnormal tissue formation that cause the vaginal extension, he chose to have the patient on Cryotherapy.
Cryotherapy is a technique used to destroy abnormal tissue by freezing it. It is also called crysosurgery. Since our hospital cater to operable clean cases, the patient had to be brought again to another hospital where the OB-Gyne could perform the surgery.
Cryosurgery is method of treatment used for cervical dysplasia, or abnormal cells on the cervix. It may also be performed in very early staged cervical cancer. If left untreated, these abnormal cells may develop into cervical cancer. Cryosurgery is also called cryotherapy. Cryosurgery kills pre-cancerous and cancerous cells by freezing them.
During cryosurgery, a doctor will insert a speculum into the vagina. A probe is inserted into the vagina that releases a gas that freezes the abnormal cells. It is left in for three minutes until ice crystals form on the cells. The process may be repeated after waiting for an additional three minutes. (Source: about.com)
It only took her half a day in that hospital and she was brought in our hospital again and she was already able to ambulate.
According to the doctor, she might have blood-tinged discharges that will go away after a couple of days.
The patient has been discharged and was then advised to come to an OB-Gyne in her place for follow up check up.
Also, it is important that every woman should get vaccinated to prevent cervical cancer.
It is just amazing how God sends his angels to heal those who are sick.

Smokin’ hot invention

morning sniffles — Sat, 03 Sep 2011 14:50:38 +0000

I once saw it on a local reality TV. Pepe Smith’s kids were desperate to take him off the cigarette smoking habit that caused him serious lung disease. His daughters have thought of buying him e cigarette that mimics a real cigarette minus the deadly nicotine and smoke. Smith found it weird at first but in the end he got the hang of it and swore by it. There are really cool inventions that are perfect substitutes for some stuff.

War against fat

morning sniffles — Sun, 28 Aug 2011 15:46:04 +0000

It is a very long weekend and what is the best way to spend it during this rainy times? Curl up in bed while hopping on from channel to another. Glad that cable service remains uninterrupted.
Filling myself with Hollywood buzz,I stumbled upon ET Weekend’s take on Hollywood weight wars. From Oprah’s yoyo diet, to Kirstie Alley’s dance diets. Each of the stars has really worked their way to achieving a health bod that is like finding the best weight loss pills that work for you.

A night full of learning (Part 1)

morning sniffles — Sat, 20 Aug 2011 07:10:37 +0000

One has undergone transradial coronary angiography that revealed one-vessel disease of the left anterior descending artery (diagonal). As he was sent back to his room, the management to his disease was discussed.
The order says possible FFR (fractional flow reserve/transradial PCI or percutaneous coronary intervention.
According to ptca.org Fractional Flow Reserve, or FFR, is a guide wire-based procedure that can accurately measure blood pressure and flow through a specific part of the coronary artery. FFR is done through a standard diagnostic catheter at the time of a coronary angiogram (a.k.a. cardiac catheterization). The measurement of Fractional Flow Reserve has been shown useful in assessing whether or not to perform angioplasty or stenting on “intermediate” blockages.
Stenting is one of the interventions considered to open up a narrowed vessel to increase the blood flow that goes in and out of the heart.
The first instinct or consideration made is to stent a block that is more than 50% to give in the “oculo-stenotic reflex but if FFR is done, blood flow in the affected vessel could be determined and will further call for a more sound decision of whether or not to stent the vessel.
A stent would cost around P80,000 – P100,000 and additional fee for the FFR would not as expensive as that .
The special guide wire crosses the lesion and is able to measure the flow and pressure of the blood. Results are displayed on a special monitor (left) along with the “FFR value”. Studies have shown that an FFR value less than 0.75 or 0.80 corresponds to inducible ischemia, and most likely will require interventional treatment. Blockages that score above this threshold can be safely and adequately treated by medical therapy without the need for angioplasty. (ptca.org)
This has been existing along with the discovery of angiogplasty but due to size in circumference that will fit in a vessel it has somehow virtually died. Recent innovations though gave birth to devices that uses smaller Dopplers which does not need any balloons.
As mentioned, it is usually done during the coronary angiogram but for some reason, the interventionist has reserved it to be done after it and before considering transradial PCI.
I was the charge nurse one night and in my rounds I mentioned to the patient the preparation for the procedure including the needed downpayment. Although he is under an insurance company, he said that they are still to decide if they will be going for the procedure. That is what I endorsed to the incoming charge nurse and the next day that I came in, the patient has been discharged.
I hope that he made a very wise decision as his condition needs special attention.

A good vice

morning sniffles — Sat, 13 Aug 2011 14:33:22 +0000

I really love the sporty atmosphere in the ward. My colleagues are into maintaining a healthy lifestyle amidst the sticky situation in the hospital. Since it is raining, I did not have the luxury of time doing my routing run. I offered my water proof MP3 to my colleague who plans to run 21k in the next leg of the Unliab Run. He politely declined my offer and said that he just need to find water proof accessories for ipod so he could have has MP3 playing even in the rain.

Eisenmenger Syndrome and everything

morning sniffles — Tue, 19 Jul 2011 12:34:36 +0000

One of the seniors in our ward was so furious. He was apparently scolded by our headnurse during the grand endorsement. As the outgoing nurse, he needs to endorse all the patients to the incoming nurses and that includes the headnurse.
Our patient was a 22-year-old female who was diagnosed to have Ventricular Septal Defect or VSD who came in due to complaint of fatigability. VSD is a congenital disease or present at birth and is characterized by a hole or a shunt in the lower chambers (right and left) of the heart.
Anatomically, the blood flows from the superior and inferior vena cava to right atrium down to the right ventricle going to the pulmonary artery to the lungs for oxygenation then to the pulmonary vein to the left atrium down to the left ventricle then pumped out to the systemic circulation. With the VSD, the oxygenated blood coming from the left atrium leaks back to the right ventricle which mixing with unoxygenated blood then goes back to the lungs that cause too much blood pressure in the lungs that causes pulmonary hypertension. Also, the shunt allows for the poorly oxygenated blood to enter the left ventricle that causes the blood to circulate the system.
Our female patient was diagnosed to have Eisenmenger Syndrome which is associated with the high blood pressure in the lungs or the pulmonary hypertension caused by the VSD. The mean pulmonary artery pressure (mPAP) is ≥25 mmHg at rest or ≥30 mmHg with exercise (Barst et al 2004).
Eisenmenger’s Syndromes signs and symptoms include:
• Abnormal heart rhythm (arrhythmia)
• Bluish lips, fingers, toes, and skin (cyanosis)
• Chest pain
• Coughing up blood
• Dizziness
• Fainting
• Feeling tired
• Shortness of breath
• Stroke
• Swelling in the joints caused by too much uric acid (gout)
Complete blood count revealed increased levels which is common presentation of the syndrome. She underwent phlebotomy. Older children with symptoms may have blood removed from the body (phlebotomy) to reduce the number of red blood cells, and then receive fluids to replace the lost blood (volume replacement).
Heart murmur or an abnormal heart sound can also be heard and this was among the questions of our headnurse. I do not know but based on the feedback I received from my co-staff nurses, what our headnurse did was a bit out of bounds. The senior nurse felt belittled. It is one thing that she knows something that we do not know but it is another to guide us to learning the ropes of cardiac nursing.
Searching the internet, I landed on kidshealth.org. A heart murmur is a whooshing sound between the beats that a doctor hears through a stethoscope. The whoosh is just an extra noise that the blood makes as it flows through the heart. Normal heart sounds are called “lub-dub”.
The heart makes a “lub” sound with the closing of the valves that control blood flow from the upper chambers to the lower chambers. Then, as the valves controlling blood going out of the heart close, you will hear the sound “dub.”
Murmurs have grades. Grade 1 is the softest-sounding murmur, and Grade 6 is the loudest. A murmur graded 4, 5, or 6 is so loud you can actually feel a rumbling from it under the skin if you put your hand on the person’s chest.
There is no treatment for this type of condition and the treatment is palliative or based on the presenting complication. The pulmonary hypertension may be treated with prostacyclin and endothelin antagonists.
Viagra, which is the common form of Sildenafil is used to treat pulmonary hypertension that helps dilate the pulmonary arteries.
Prophylaxis against endocarditis is also recommended. Once developed, life expectancy for patients with Eisenmenger Syndrome depends on the type and severity of the underlying defect and right ventricular function, and ranges from 20 to 50 years.
According to Mayoclinic. Com, doctors do not recommended surgery once Eisenmenger syndrome has been developed although some may benefit from heart and lung transplantation or lung transplant with repair of the hole in the heart.
Next time that our headnurse will throw a big stone of a question at us, I will make sure that I have my armor.

Having too much of a good thing

morning sniffles — Thu, 30 Jun 2011 16:17:28 +0000

In my quest to catch my elusive sleep last night, I chanced upon a documentary show on Bio channel titled Obsessed. It featured two individuals who are battling a mental condition called Obsessive-compulsive disorder or OCD.
The first case was a married woman in her early 30s. She has been suffering from OCD since 5 years old. The problem according to her has stemmed, when she was abused on a school bus at that age. She felt dirty in the inside and she channelled her hunger to clean her innerself by obsessing with having clean surroundings. The OCD got worse when contracted MRSA or the methicillin-resistant Staphylococcus aureus (S. aureus) bacteria putting her quest for perpetual cleanliness into a great hype.
She caves into her obsession making her compulsive and cleaning every inch of her household. She wakes up so early cleaning up everything in their home repetitively. She straightens out the fringes on her carpet rug using a fork and cleans every corner of their furniture pieces using Q-Tips. Although she feels tired and she knows that everything is already clean and in order, she just cannot fight the urge forcing her to stay up until wee hours in the morning scrubbing everything she sees and thinks dirty.
While in Florida, a 26-year old man is also suffering from OCD obsessed in checking and ensuring that every faucet, door, stove and electric appliance is properly shut down. He uses a checklist doing the routine of checking every piece of it not one, not twice but at least four times before tucking himself at night. However, the obsession does not end when he hits the bed, he still tosses and turns in bed being bugged by the thought that he might have forgotten to shut down something completely. The obsession stems from his childhood experience when he left the faucet at home open and left. He was traumatized by the thought that their house flooded. Although no one blamed him for the accident, the event kept traumatizing him until today. He has lost a good music deal while in Switzerland due to his OCD when he kept on checking the hotel door’s every so often that the band was not able to finish recording.
It was really painful watching them struggle to fight their obsessions. The woman’s relationship with her family has been greatly affected. She cannot even sit down with them at the dinner table as she tries to finish scrubbing the sink. She really felt exhausted but her obsession keeps on pulsating in her mind. She even had to ask her kids to clean objects and places again and again even if they were not dirty at all.
On the other hand, the man’s partner does not get good night sleep as she gets awakened by the man’s constant trip to the kitchen and living room to check on doors, plugs and switches.
According to medicine.net

An obsession is defined as a thought, impulse, or image that either recurs or persists and causes severe anxiety. These thoughts are irresistible to the OCD sufferer despite the person’s realizing that these thoughts are irrational. Examples of obsessions include worries about germs/cleanliness or about safety or order. A compulsion is a ritual/behavior that the individual with OCD engages in repeatedly, either because of their obsessions or according to a rigid set of rules.

Being physically exhausted thinking and doing things repeatedly, affecting their relationship with their significant others and their performance of activities of daily living, they have agreed to undergo intervention therapy that involves OCD therapists. They were asked to face their fears by exposing them to the things that increases their anxiety.
The woman was brought out to a public toilet where she was asked to touch the toilet seat for 15 seconds and she was not allowed to wash her hand for 5 minutes. Her anxiety grew as she rated upto 8 out of 10. She survived the day but she was really in tears. After 8 weeks of continuous therapy sessions, she was asked to do a, yet, major challenge. She was asked to go out in an amusement park and spend the whole day with the family. At first, she was jittery, but as she tried on conquering her obsession, it turned out well. She had a blast and she was really up on her feet to overcome the major challenges her disorders is going to put on the table.
On the other hand, the man was exposed to things that make him jitter. The OCD therapist opened the faucet and let the water fall in the sink and he opened the gas stove while they are sitting in the living room. After a few attempts the man succeeded in overcoming his obsession to come into the kitchen and switch all the things off.
The next step was keeping all the same stuff open all throughout the night as the man was trying to sleep in his room with his partner at night. The first few nights were a struggle as night vision camera placed in his room and kitchen showed that he kept tossing and turningfighting his obsession but in the end he caved in. It took him a while to control his anxiety.
After 3 weeks of intervention and close monitoring, his OCD therapist has decided to take the exposure to its highest limit. He kept the faucet in the patient’s house open and they went out with his family to see him play his music. He succeeded.
The treatment, according to the OCD therapists, is a life long process and the person affected needs a strong support system to win the battle.
I am now hooked on the show as I want to explore the different sides of OCD.

“Coming out” and being accepted

morning sniffles — Tue, 21 Jun 2011 16:13:13 +0000

I have a 28-year-old friend who works in a call center. He has been in and out of the hospital due to complaints of difficulty breathing, chest pain and easy fatigability. He does not smoke and drinks occasionally. He has been re-admitted due to the same symptoms and this time he needs to be placed on oxygen to aide his breathing. Chest CT scan revealed diffused interstitial pneumocystis and they are suspecting HIV.
He has been referred to an Infectious Disease Specialist but since his mother was there all the time, the doctor cannot expound on my friend’s sexual activity. Well, we have known his sexual preference for the longest but it is really hard to break the news to his mother. Hearing his unsafe sexual activity, which according to him, is common in the call center place and the gym, it is not really impossible for him to catch the disease.
The IDS doctor requested for a sputum staining to test for Pneumocystis Carinii Pneumonia infection and unfortunately the test is not available in the hospital where he is admitted. Respitory discharge needs to be submitted and be brought to a hospital that cater the Indirect Fluorescent Antigen study or IFA which is 97% reliable in confirming PCP. PCP is common among HIV positive patients. It is a kind of pneumonia caused by bacteria called Pneumocystis jiroveci which is classified as fungal pneumonia. It is the most common opportunistic infection among HIV positive patients.
The first signs of PCP are difficulty breathing, fever, and a dry cough which are the spot on signs manifested by my poor friend.
Upon admission he has been placed on IV antibiotics such as Meropenem and Fluconazole (which is actually an antifungal medicine). He is also on antibiotic pill Cotrimoxazole Bactrim Forte. My online research agrees that Trimethoprim-sulfamethoxazole (TMP-SMX) has been shown to be as effective as intravenous pentamidine and more effective than other alternative treatment regimens
HIV can only be passed from person to person through body fluids, such as blood, semen and vaginal fluid. Children born to infected mothers can also become infected during pregnancy. HIV causes AIDS by damaging the immune system cells until the immune system can no longer fight off other infections that it would usually be able to prevent.
It takes around ten years on average for someone with HIV to develop AIDS.
The most common ways HIV is passed are:
There are various ways a person can become infected with HIV:
• Unprotected sexual intercourse with an infected person: Sexual intercourse without a condom carries the risk of HIV infection.
• Contact with an infected person’s blood: If sufficient blood from somebody who has HIV enters someone else’s body, then HIV can be passed on in the blood.
• Use of infected blood products: Many people in the past have been infected with HIV by the use of blood transfusions and blood products which were contaminated with the virus. In much of the world this is no longer a significant risk, as blood donations are routinely tested for HIV.
• Injecting drugs: HIV can be passed on when injecting equipment that has been used by an infected person is then used by someone else. In many parts of the world, often because it is illegal to possess them, injecting equipment or works are shared.
• From mother to child: HIV can be transmitted from an infected woman to her baby during pregnancy, delivery and breastfeeding.
Source: www.avert.org
I do not understand but he has not been placed on ELISA which is the definitive test for HIV infection but I have secretly discussed the matter with my friend. detects HIV antibodies in a person’s blood. It is necessary to wait at least 3 months which is called the window period after the last possible exposure before having an HIV antibody test, to be certain of an accurate result.
I just do not know how he could come out to his parent which is badly needed. He is worried about the stigma that he needs to face if his health condition also becomes known to the public.
I hope that it is not PCP.