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.

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.

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.

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.

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.