In the Headlights

Pet CPR

My friend, RR, and her husband went through a traumatic experience last night, but it was nothing to what their dog, Holly went through.

They have several dogs, pretty big ones, all rescued animals.  They buy big soup bones for the dogs, who have come to expect this treat.  Yesterday, the store was out of the bones, so they bought those dried pigs' hooves, and gave them to the dogs.

A little later, R heard a strange noise, which she first thought was the death rattle of her washing machine, but further investigation led her to Holly, whose eyes had rolled into her head and whose body was moving spasmodically.  Seizure?  Heart attack?  Stroke?  Holly 14, did the international sign that says "I'm choking" (please check this link after reading the rest of the post).  Of course she didn't, but R figure thing out pretty quickly and tried, unsuccessfully, to get Holly's mouth open.  She tried the Heimlich, unsuccessfully as well.

Her husband came to help, and by now, Holly was out, not breathing.  They tried mouth-to-nose resuscitation, unsuccessfully.  She couldn't get the chest to rise.  Her husband had her pull the dog's tongue out, while he placed her on her right side and started CPR.

By now, they were convinced they had a dead dog.  They tried one more time to open her mouth, and were able to this time.  He reached in and felt something in the back of her throat, but wasn't able to extract it.  She tried, and having smaller hands, was able to grasp the object, which she pulled out.  A piece of pig trotter bigger than a golf ball.

A little more CPR, some mouth-to-nose, and when they stopped to assess, Holly took a couple of breaths.  A few minutes more, she opened her eyes.  R says when she looked into those eyes, she knew Holly hadn't sustained any brain damage.

A little later, they took her outside, and said she looked around dazed, as if at a bright new world.  Today, R says she is her normal self.  The picture above was taken today.

Go to the link for instructions on doggie CPR, and this one for kitty CPR.  I think these are adaptable for most pets (e.g. if you have a skunk, try the cat CPR).  If you have a horse, you can try here.  Most horse CPR links had to do with CPR leather cleaner, but this one is about resuscitation.

If you have pets, they're worth a look.

Women are NOT Like Men

I heard an interesting story about the differences between men and women in heart disease (in addition to all the other stuff) on NPR yesterday on "Your Health". 

We have long heard that heart disease is harder to detect in women, that women are underdiagnosed and treated for this disease, that women are different.

It is emerging that indeed they are, and this story focuses on the fact that the difference may be in how the sexes store fat.  Just as a man tends to store his around the middle where a woman would spread it all over (generalization, I know, but often the case), so do they deposit fate and cholesterol in their arteries.

Where men with chest pain go through the tests:  ECG, stress test, cardiac catheterization, women are more likely to have a non-diagnostic stress test, but if they go for catheterization, it is less likely that they will have the discreet lesions more commonly seen in men.  This is because they distribute the cholesterol more or less uniformly along the artery, so that when dye is injected into the vessel, there appear to be no narrowings...the whole thing is narrowed.  The discreet, specific narrowings that are treatable with angioplasty or bypass are not seen, and the women are often told they have no disease.

Another issue is that women have more disease of their small coronary vessels--again less visible and treatable--than do men.  Thus the disease in women is more responsive to diet, exercise and medication than to high-tech procedures and surgery.

The good news is that the treatment does not involve splitting your chest.  The bad news is that small vessels occlude more easily.

This link takes you to the NPR story.

This issue was also discussed in February on "All Things Considered", highlighting "hidden" heart disease in women, and the fact that many women are given a clean bill of health, only to go on and have a heart attack.  Dr. Noel Bairey Merz talks about this phenomenon and W.I.S.E., the Women's Ischemia Syndrome Evaluation study.

[Artery photo from the NPR story.]

Truth or Urban Legend?

A story circulating for a month or two tells of a team of scientists swabbing the bottom of women's purses and growing bacteria proving that the purses were dirtier than the inside of a dog's mouth.

It's true.  According to Urban Legends, the testers "found evidence of fecal contamination, e.coli, salmonella, and other forms of bacteria. 'Some purses' noted reporter Eric Wilkinson of King 5 News in Seattle 'are 100 times dirtier than the average toilet seat.'"

Presumably, the reason is that women put their purses on the floor in public rest rooms.  Some emails circulating recommend cleaning the purposes with disinfectant wipes.  I don't know what that would do to your purse, but I'm reluctant to find out what it will do to black leather.  Having said that, I don't know the answer.  Sometimes there is no choice but the floor.

One thing that can be avoided:  Don't put your purse on the table or kitchen counter when you get home.  Knowing what you know, it's a good idea to keep purse and food apart.

[Germ from Harvard University Health Sciences site.

Glass Art

Dale Chihuly exhibit in the Gonda Building, Mayo Clinic, Rochester, Minnesota.

A Window into Medicine

I recently had occasion to visit Rochester Minnesota, home of the Mayo Clinic.

No, no, really, I'm fine.  No cause for alarm.  I was there on business.

I was lucky enough to have someone who'd been there a long time give me a tour.

One outstanding sight was this stained glass window in the home of William James Mayo, one of the Mayo brothers.  The window was completed and installed in March, 1943.

Each vertical panel illustrates on of Mayo Clinic's three shields:  Education, Practice and Research.  Temporally, the earliest are on the bottom (500 B.C. to 1500 A.D.), followed by 1500-1800, 1800-1900, and 1900 and later, reading lowest to highest, so that the topmost lights reflect the most modern era.

A full description of each panel of the window can be found here.

Good to Know I'm Doing Something Right

A recent report in the Archives of Internal Medicine, which got a lot of attention in the media, confirms in a large study what had been shown in smaller studies in the past:  caffeine protects the liver from the ravages of alcoholic cirrhosis.

Studying more than 125,000 people, the study demonstrated that the risk of alcoholic cirrhosis decreased about 20% for each cup of coffee a person drank each day.  Four or more cups of coffee a day reduced the risk by 80%. 

Liver enzymes, which go up with liver disease, were reduced in coffee drinkers when compared with non-coffee drinkers, with the highest correlation in the group that drank the heaviest.

No correlation was seen with tea drinkers, indicating that caffeine is not the protective element.

No significant benefits were found in liver disease from other causes.

They stress that the best way to avoid alcoholic liver disease is avoiding excessive intake of alcohol. 

*     *     *     *     *

Rats.  I thought I had it all figured out.  Drink wine to keep my coronary arteries clean.  Then drink coffee to keep my liver safe from the alcohol.  Then more wine so I can sleep after drinking all that caffeine. And to keep my coronaries clean. Then lots of coffee to get going after drinking the wine.  And to keep my liver safe.  The circle of life.

[Wine illustration from Wikipedia.  Coffee from Jeremiah's Pick Coffee Co.]

Body Works

Yes, it does.  And remarkably well, too.

When I read Stiff, I did a post about Korperwelten, or Body Works, in which bodies had their fluids replaced with plastics for teaching of medical personnel.  An exhibit of preserved persons has toured the country (indeed, several from Dr. Gunther von Hagens and other plastinators are on tour as we speak).

I was fascinated by the idea and ordered the DVD called "Body Works". You can select English, French, Dutch or German narration.  The DVD is fabulous.  It starts with a segment about plastination itself, from the careful anatomic dissection through the permanent fixation itself.  Then it goes through the body system by system with illustrations from plastinated cadavers. I don't know if I am more amazed by the beautiful and elegant renderings or by the fantastic anatomy displayed, along with some fascinating facts and factoids (e.g. if your blood vessels were placed end to end, they could circle the globe at the Equator twice.  The specimens are poignantly human.  Some have had joint replacement surgery, some back surgery, some arterial grafting.  Some have cancer, some atherosclerosis.

Each organ system is displayed and a lot of physiology is explained.

Then Dr. von Hagens talks a bit about the origins or plastination.  It is an entirely voluntary program.

It is tasteful from beginning to end.  I was going to say that it is not for the squeamish, but the display is being viewed by thousands every day.  I bought the DVD to give to my seven year old nephew, and feel confident that he will have an advantage in science, biology, and anatomy in school for years to come.  And before I send it to him, I will take it to my parents' house and watch it there with them.  Mom's interested in stuff like that.  If you are more squeamish than my seven year old nephew or my Mom, then skip it.  Otherwise, it's a satisfying way to pass an hour.

Your Mind On, and Off, Drugs

A recent article in TIME (March 27, if you must know) reported on growing interest in hypnosis within the medical field.  Not just to quit smoking or biting fingernails, but in lieu of anesthesia.

They cited a patient undergoing a 30-minute procedure with no anesthetic and no discernible pain.  "Her hypnotherapist was by her side throughout,monitoring her trance state and refocusing her mind when it drifted.

Thousands of procedures have been done under hypnosis, but more commonly with hypnosis as a complement to anesthesia (you aren't out of a job, all you anesthesia providers). 

At University Hospital of Liege in Belgium, a team of doctors has logged more than 5100 surgeries by hypnosedation, replacing general anesthesia with hypnosis, general anesthesia and a mild sedative. 

The technique is becoming popular in Europe where studies show that patients suffer fewer side effects than fully sedated ones.  Since they get by on less than 1% of the standard medications required for general anesthesia, avoiding such side effects as nausea, fatigue, and cognitive impairment.  One study by Dr. Marie Faymonville in Liege found tht the typical hypnosedated patient returned to work 15 days after surgery, compared with 28 days for a fully anesthetized patient.

Another study using heat producing thermodes to produce pain, hypnotized patients reported feeling pain at a level of three or lower, compared with non-hypnotized reporting eight or higher, on a ten point scale.

Brain scans have shown pain signals going from the brain stem through the midbrain to the cortex where it is consciously sensed.  In hypnotized patients, the sensory cortex remained inactive--the pain message was not being consciously received.

One doctor in Iowa uses hypnosis to reduce pain and anxiety while patients receive presurgical nerve blocks, and finds that the effects often last through the entire operation.

*    *    *    *    *

It's not all beer and skittles, though.  they end the article by saying that 60% of patients are hypnotizable to some degree, an additional 15% highly so.  The rest seem unresponsive. 

Many surgeries can be performed with sedation and local anesthetic.  It is not clear here when patients return to work 15 days after surgery while those who had a full general  anesthetic took 28, whether they are comparing the same surgery in an age and health matched population.  I think much more needs to be done before the answers are in, but this is a very intriguing concept.

I recently wrote about a resurfacing interest in Transcendental Meditation on my part.  I suspect that individuals who meditate and do so before surgery would probably have similar results. The mind is a fascinating plastic organ.

So What the Heck Is "The King's Evil"?

I am reading Stiff by Mary Roach, about the lives of cadavers.  Full disclosure when I am done.  (Briefly, I am greatly enjoying it.  And I already know who's going to get it when I am done.)

In one section, she talks some of the diseases that were described in the Middle Ages and thereafter, that you may have run across in your reading, and wondered about. Actually, this chapter is not about the diseases, per se, but about how they were treated at the time, with tinctures and potions made from human secretions, excretions, hair, nails and mummified body parts. To name only some of the state-of-the art treatments. The name of the chapter is "Eat Me".

While you're chewing on that, I'm looking up some of these diseases.

Scrofula:  Technically, cervical tuberculous lymphadenopathy, Scrofula is invasion of the lymph glands in the neck by TB, causing a painless but unsightly growth.  Because they had no  Rifampin or Isoniazid at the time (nor any of the more modern miracle drugs, which are not doing such a hot job of keeping TB in check), the cure for this disease was the royal touch, which led to the disease being known as the King's Evil (aye, and so's the Queen).  Kept those kings pretty busy, back in the day.

Dropsy: Derived from the Greek "hydrops" which in turn came from the Greek "hydor" meaning water, dropsy refers to edema or swelling of the tissues from accumulation of water.  I had dropsy equated in my mind with congestive heart failure, but from my exploration, it looks like it could have any of a number of etiologies, cardiac, renal, poor diet.  When I put "dropsy" into Wikipedia, it took me right to the "edema" page.

Quinsy:  This is a peritonsilar abscess, which can lead to sepsis or airway obstruction.  According to Wikipedia, George Washington may have died of this.  It may have started as a cold/fever/sore throat, progressing to laryngitis and pneumonia.  His death may have been from a combination of shock (from dehydration and bloodletting), and asphyxia, and possibly sepsis as well.

Glanders: This infectious disease of horses, donkeys and  can be contracted by humans in close contact with animals carrying the bacterium Burkholderia mallei.  The acute form leads to septicemia and death within days.

Farcy:  A chronic form of glanders, this disease affects chiefly the skin and superficial lymph vessels.

*     *     *     *     *

Feel free to chime in with any other whimsical sounding but deadly disorders. 

[Scrofula image from Wikipedia]

Altitude Sickness

I almost called this post "attitutde sickness".  Why?  Because I just had a poor 5 hours of sleep and awake to find myself still in a hotel at Dallas/Ft. Worth Airport, looking forward to spending the day hoping my 11 AM flight makes it off the ground, then retrieving my car on the other end, going home, doing laundry, unpacking and the like.

Then I remembered.  This hotel has an in-room coffee pot (not only good per se, but will help wash away the cotton mouth--almost made that one word, but then it's a snake, no?-- I have due to the fact that my toothbrush and toothpaste are in my suitcase at an undisclosed location.)  And they serve breakfast, so before I leave for the airport, I will have something in my stomach.  And I'm looking forward to having dinner with my folks tonight.

See, if I wait long enough, my true Polyanna nature will rise to the surface.

*     *     *     *     *

The reason altitude sickness came up is because Shawn and I (who both come from sea level)just vacationed in Salt Lake City, which sits at 4000+ feet in altitude.  And Wednesday, we went with her convention group and took a bus into the mountains, for shopping, a sleigh ride and dinner.  On the way up to Park City,in the Wasatch Mountain Range, Shawn mentioned that her ears were popping. Park City itself is at 6900 feet.

Shawn was looking out the bus window as the driver sped through a driving snow storm, and she wondered out loud what would happen if the bus took the notion to go rolling down the hill.  I said I was more worried about altitude sickness which can occur at 5000-11,500 feet, thereby giving her something else to mull over. A friend of mine got a mild case of this visiting the Alps, and relates being miserable, but at least he had no lasting effects.

Symptoms include headache, shortness of breath, rapid heart beat, dizziness, nausea, and, in serious cases, pulmonary edema or cerebral edema, which can be fatal. The best way to avoid it is gradual acclimatization.  Also recommended are generous intake of fluids and avoidance of alcohol.  A drug called acetazolamide can be used, but takes hours to days to work.  

At high altitudes, the atmospheric pressure is lower, and each breath delivers less oxygen to the lungs.  This makes you breathe faster, which causes a reduction of carbon dioxide in the blood called respiratory alkalosis.  Taking acetazolamide causes the kidneys to excrete bicarbonate, reacidifying the blood (metabolic acidosis) to balance the alkalosis.  Serious hikers can take days or weeks to acclimate, and may take acetazolamide, but that also takes days to really work.  We didn't have that kind of time.

Fortunately, we did fine.  I did notice some rapid breathing and rapid heartbeat in myself as we were walking around Park City, but that may have been due to the price tags we looked at in the shops. 

And best of all, the bus didn't roll off the road.

[Goat illustration from The Backpacker.  Check out the link for more great photos.]