Working in a hospital that specializes in cardiac cases, it always a learning experience for me taking on new cases. Like being assigned to a patient who broke her left should and was diagnosed close fracture humeral head, left. I learned from the ortho-surgeon that it is not being operated on. Instead, an arm-sling will just be in place at all times and the patient will be on anti inflammatory medications for a long time. It is different from the aircast-airsport-ankle-brace that is being used on some who has dislocated or snapped ankles.

This is a case of a 69 year-old female who was flown in from the Federated States of Micronesia due to chief complaint of difficulty breathing.
The problem started about three months prior to admission when she started to complain of chest heaviness accompanied by difficulty breathing and shortness of breath. She has been admitted in a local hospital in her country and was diagnosed to have COPD or Chronic Obstructive Pulmonary Disease and was discharged after being stable.
COPD is a progressive disease that makes it hard to breathe. “Progressive” means the disease gets worse over time. (source NHLBI)
After a month, she was re-admitted due to left sided pleuritic pain and was diagnosed with Community Acquired Pneumonia. She was responsive to IV antibiotics and manifested clinical improvements hence discharged.
Until ten days after being discharged, she complained of bilateral chest discomfort associated with shortness of breath and easy fatigability with positive 2-3 pillow orthopnea. She was then referred to our institution suspecting Coronary Artery Disease, congestive heart failure, to consider pulmonary embolism and pulmonary carcinoma.
The patient cannot speak English and only through her husband we could learn what is troubling her.
She was able to tolerate pulling urine flow of about 2.3 to 2.8 per session which is the target until her last session where her blood pressure drop down to 80s systolic. After pulling about 800cc of fluid, she became unstable. Dopamine drip was started on her to bring her BP up and he was brought back to her room for further evaluation.
Since she is anuric or does not produce urine, she was also referred to a kidney specialist called the nephrologist for dialysis three times a week.
She has been referred to a pulmonologist who ordered for a chest CT scan which revealed normal findings. Then, doctors suspected reproductive cancer involvement which prompted to think of referral to an Obstetrician Gynecologist. Considering ovarian cancer and multiple myeloma, the nehprologist request to run some tests on her such as the CA-125 and Serum protein electrophoresis.
According to medicine.com CA 125 is a protein that is a so-called tumor marker or biomarker, which is a substance that is found in greater concentration in tumor cells than in other cells of the body. In particular, CA 125 is present in greater concentration in ovarian cancer cells than in other cells.CA stands for cancer antigen measured through blood sample
The result was insignificant but the Serum protein electrophoresis particularly the gamma globulin proteins test was particularly high. This test measures the types of protein in the fluid (serum) part of a blood sample.
Serum proteins are classified as albumin or globulins. Albumin is the protein of highest concentration in the serum. It carries many small molecules, but is also important for keeping fluid from leaking out from the blood vessels into the tissues that is why it is called the gate keeper.
Increased gamma globulin proteins may indicate:
• Multiple myeloma
• Chronic inflammatory disease (e.g., rheumatoid arthritis, SLE)
• Hyperimmunization
• Acute infection
• Waldenstrom’s macroglobulinemia
• Chronic liver disease
Patient also started to complain of back pain. The nephrologist suggested to refer the patient to a haematologist of a blood disease specialist. The following day, the haematologist ordered for a bone marrow biopsy through bone marrow aspiration. The patient was placed on side lying position assuming a shrimp or fetal position to open the spinal cord. Through bone marrow aspiration a small amount of bone marrow fluid and cells are collected through a needle put into a bone. The bone marrow fluid and cells are checked for problems with any of the blood cells made in the bone marrow this time biopsy was made. Blood disorders such as leukemia, certain anemias, or problems that affect the bone marrow, such as multiple myeloma or polycythemia vera can be determined and staged.
The sample was sent to another hospital as we do not have the facility to perform such as test. Two days went on and the result came in Thursday morning and it was confirmed that the patient has Multiple myeloma is which is a cancer of the plasma cells in bone marrow. Plasma cells help the body’s immune system fight disease by producing proteins called antibodies. In multiple myeloma, plasma cells grow out of control in the bone marrow and form tumors in the areas of solid bone.
The growth of these bone tumors makes it harder for the bone marrow to make red blood cells, white blood cells, and platelets. This causes anemia, which makes a person more likely to get infections and have abnormal bleeding. (source medline.com)
The haematologist said that patient’s case had less than 40% survival and the insurance will no longer cover expenses for such a case. Nevertheless, the specialist wanted to start her on oral chemotherapy ASAP.
But things happened so quickly. That night, the patient complained on difficulty breathing, also she has been placed on non-invasive ventilator (NIV) she was so restless that she kept on pulling the face mask. We have instructed her husband to convince her to keep the face mask in place to help her breathe. The patient progressively became restless that she pulled everything including her IV line. Her acid-blood gas revealed respiratory acidosis and sodium bicarbonate needed to be pushed through IV line. The bedside nurse then was trying her hardest to tame the patient and to insert a new IV line. She went out to get help from a fellow nurse but when she came back, the patient was pulseless. She immediately performed chest compression and instructed the other nurse to sound a code. Efforts to revive her failed. She was pronounced dead at 1:35 in the morning.
Final diagnosis was: Acute Cardiorespiratory Failure, COPD, Chronic Renal Failure (End Stage Renal Disease), Multiple Myeloma.

I just created an account on Twitter and I started to follow local and international celebrities. It is interesting to know that apart from food, fashion and travel, most of them are trying to squeeze in physical workouts to make sure that they are in the pink of health and of course constant eye candies. Some of them have gone to suboxone treatment detox centers centers to make sure that they will start afresh. I hope that I have the time and resources to focus on my physical well being.

I have skipped so many summer outings for the past couple of years. Simply because, I feel , and actually I have gained weight. I cannot fit into any of my swim suits and it is really disappointing. I have started to eat right and I cut down on chugging down sodas and the pounds that I have shed were not enough to look good in my bathing suit. I really applaud those who really worked hard to get their ripped body. They seem to get the oxyelite pro results by having their personal trainers and chefs that custom fit their work out and diet regimens.

During my very rare idle time in the hospital, I got to maximize our internet time browsing Yahoo Health and I came across the information about coffee being proven to be a healthy bean.
In that Yahoo article, it said that study showed that coffee whether in its pure caffeinated glory or devoid of its caffeine, plays a very important role in preventing the occurrence of breast cancer.
Being a coffee addict, I rejoiced! At least I would not be having so much guilt while having a fix of caffeine at least every morning. But wait there is more, The NBC Nightly News featured that Harvard School of Public Health, confirmed that coffee, whether decaf or caffeinated, lowered the incidence by 60% among their subjects the risk for developing prostate cancer.
In March 1981, the office released a study stating that drinking coffee puts a person at developing pancreatic cancer but they have taken it back stating in their official statement that the latest discovery has been proven to be more reliable.
Cheers to the caffeine fix!

There are some weird things that you will come across with, one way or another. As I watch Today Weekend, I have learned something about a health condition called prosopagnosia or simply the face blindness which is the inability to recognize faces even if they have encountered those persons a number of times. The persons include their family members, friends or even themselves. It is not categorized though as memory impairment problem.
There are two types of prosopagnosia:
Developmental prosopagnosia is one that is present since childhood. A child does not recognize faces as well as other people do. On the other hand, acquired prosopagnosia may occur after brain damage from head injury, stroke, or neurodegenerative diseases. Individuals with this type had normal face recognition abilities in the past, but this has been impaired or lost due to brain injury. (source: raredisease.about.com)
Right now, there is no cure for this rare disease. Like the woman suffering from this disorder that I saw on Today Weekend, she learned other ways of remembering people around her particularly her kids. She remembers the clothes they wear for that day. That way, she will have an aide in knowing who her kids are when she picks them up from school. Other clues are hair, gait and voice.

It is amazing how natural thing works specifically on my body. I lost about 3 kilos by just running about 6 kilometers atleast twice a week. I really wanted to take my running seriously but my erratic work sked does not allow me to do so. Also, the safest place to run around is really far from my place. I would be surprised if one day I purchased lipozene just to have a continuity in weight loss.

We had this patient since July of 2010. She was diagnosed with Parkinson’s disease. She was readmitted due to fever and productive cough.
At 84 years old, she can no longer perform activities of daily living. She is positive for spastic flexion of the upper extremities and spastic extension of both lower extremities. Never spoke and opens eyes occasionally although she opens her eyes to verbal command at times. She only moans and do not communicate even in words. As such her Glasgow coma scale plays between 9 and 11. Overall, she has been stable and uneventful. Her daughter who lives with her just decided to keep her in the hospital as her daughter is always on flight as a cabin crew. The old woman is rich and has saved money in the bank that her daughter has decided to spend all her money on her hospitalization. The daughter says: it is her money anyway.
Mrs. C, a widow, has her caregiver 24/7. They are the ones performing feeding via PEG, bathing, diaper changing and basically everything. All the nurse does is to take her vital signs.
Being assigned to her the other day, I noticed that she is having skip beats. Although the beats are within normal range, I referred the matter to her attending. The cardio fellow ordered for ECG/EKG test at bedside and revealed premature atrial contractions which they suspect might be associated with electrolyte imbalance. She was then tested for serum potassium, sodium, magnesium and calcium which all turned in to be normal.
The cardiologist attending then ordered for 2D echo with Doppler studies to visualize the heart’s pumping activity. It is like the ultrasound of the heart. The results are yet to come in

I can’t help but laugh out loud after reading my nieces’ status on her facebook wall. It says that she feels inspired to go on a diet when she sees sexy women in bathing suits. However, her aim to go lighter and fitter vanishes as soon as she steps out her room and see what her mom has prepared on the table. She said that she will never win the battle against food that is why she is thinking of taking adapexin-p to cut down her excess pounds.

I was surprised to learn this morning (coming back from long days off) that our patient diagnosed to have 3-vessel disease went home against medical advice. It was for the reason of lack of funds. Having that type of disease, the patient is at risk of chest pain or worse, heart attack. In times like this, I begin to think that it is the focal point of investment to get medical insurance.
There have been patients in our institution whose medical expenses were shouldered by Medicare plan. It is about time to give it a serious thought.