Having grown up in Montana on a small ranch, I was curious about mastitis. My family raised cattle and milked our cows by hand, but rarely ever had outbreaks of mastitis…so my ‘Luddite suspicion’ was that cows were getting mastitis because modern milking machines are being too rough on their teats, OR they are milking them too much!  This is not the case at all.

a girl and her cow...

“The primary cause of mastitis in cattle, goats and sheep are well-recognized groups of microorganisms: Streptococcus sp., Staphylococcus sp., Pasteurella sp. and coliforms, Escherichia coli, Enterobacter sp., and Klebsiella sp.” These organisms like wet, warm, dark places found in dirty bedding and crowded quarters. (Mastitis, 2008)  Of course, the same bugs people get diseases from! The rGBH must be creating an environment where the pathogens overtake the normal flora of the glands and ducts of the teat. See image below:

While the article never mentions milking machines, it did say that prevention of mastitis requires your animals’ quarters be clean and dry. (Mastitis, 2008)

**Care for some Air and Light, Florence?**

So in the end, whether you are caring for animals or people, the rules for cleanliness are the same – absolutely necessary.

Now I finally understand the purpose for my constant barn cleaning regimen over the years – It wasn’t just mom trying to find me a way to stay out of the house; it was animal nursing, trying to actively prevent diseases in our animals.

source:

Mastitis in the Ewe Swartz, Helen A., Ph.D, State Sheep, Goat and Small Livestock Specialist. June 10, 2008. Retrieved on May, 2010 from: http://www.case-agworld.com/cAw.LUmast.html

It’s possible that if the “Sun-King” Louis XIV or Napoleon had a say in the matter, there would be a place where people disabled by diseases such as ALS and Alzheimer’s could be housed and helped, simply because they are citizens and have a debilitating disease.

Here’s the deal according to Prof. Pat Farmer: with ALS (Lou Gehrig’s disease) your mind and cognition are fine, while your body is being destroyed, whereas Alzheimer’s is just the opposite, a healthy body with a brain being devoured.  Yes, both are terminal and fatal (i.e. the likely cause of death for someone who has the condition).

'Napoleon's Tomb'

Les Invalides in Paris, officially Le Institution Nationale des Invalides,  was founded in 1670 by Louis XIV, “as a home and hospital for aged and unwell soldiers…” ( Les Invalides, 2010) Napoleon Bonaparte is it’s most famous fan and ‘resident’, interred at Les Invalides with other war heroes in 1840.  During his lifetime, Napoleon secured continued funding for Invalides to house and care for all of France’s soldiers who fought to defend her liberty.

(Speaking forensically…there is some controversy there; originally the cause of Napoleon’s death was given as stomach cancer, but after his body was exhumed and relocated to Invalides, it was noted that he was “fairly well-preserved”.  Upon further examiniation, large traces of arsenic ( a known tissue preservative)  were found on his body and in his hair, so it is thought that Napoleon might have been murdered.)   (Napoleon, 2010 )

Many years ago I visited this hospital on a tour.  I won’t forget the tottering old French men in wheelchairs, maimed by war, handing out flowers by the gate.  From what I could understand, they told us they “ate from the finest kitchen in Paris and we’re very content… Vive le France!”

Les Invalides L'Hospital

Today, I looked at the main homepage of the hospital at Les Invalides, where they assure “Veterans, Pensioners, and victims of war and bombings…  You have your house and doctor care; you can come in for consultation”…followed by a list of phone and room numbers for doctors within the different departments:

• “Internal Medicine and diabetologic; B. Chief physician PORTAL
• Neurology: Specialist HIA VAL-de-Grace
• Explorations echocardiographic; Professor JP OLLIVIER…etc.”  ( Institution 2009)

These diseases are so debilitating, and the help required so profound, that I propose a facility as grand as Les Invalides for people suffering from such diseases as ALS and Alzheimers. All we need to do is find the money to fund it properly.

Louis the Sun-King and Napoleon can’t be wrong!

Sources:

• Overall:  Diabetes-Type 2 patients had a 25 percent increase in risk of cancer in women, but not for men.
• Regarding the men, there was a curious finding of note; the study found that men with DM-2 were less likely than men without DM-2 to develop prostate cancer, thus lowering risk for prostate cancer. (Israeli, 2010)
• Population tested: 16,721 Diabetic Patients in the Maccabi Health Maintenance Organization, of whom 1,639 had cancer.

• These cases were correlated with 7,945 cancer patients among the HMO’s overall 83,874 clients who are not diabetics.
• To make the findings from the Haartz site easier to digest I made a table:

Most cancers mentioned are in the GI system

This study confirms another hunch doctors have had for years; due to the very nature of diabetes and the long length of time that people have it may increase their lifetime risk for cancers.

Sources:

“Israeli study: Diabetic women have 25% greater risk of developing cancer” Apr 26, 2010 by Dan Even. Retrieved on Apr 30, 2010 from: http://www.haaretz.com/hasen/spages/1165160.html

“New study claims link between Type 2 diabetes and cancer” 29 April 2010.  Retrieved on May 1, 2010 from: http://www.diabetes.org.uk/About_us/News_Landing_Page/New-study-claims-link-between-Type-2-diabetes-and-cancer/

Very self explanatory – I know there’s a difference between sucrose and fructose, etc. but just look at the pictures.

To quote a recent posting from the SugarStacks Team:

“So the good folks at the Florida Department of Citrus want their voice heard, and who are we not to oblige? Just for the record, orange juice probably is, as they say, more healthful than apple juice or grape juice.

What worries us, and the point we’re trying to make, is that when people drink orange juice like it is water, they are ingesting too much sugar. Fruit juice may have its place, but many children (and many adults) drink WAY too much juice when they should be drinking water instead.”

Tweet them at:   https://twitter.com/sugarstacker

BLOG: SugarStacks. July 17, 2009.

http://www.sugarstacks.com/blog/

Ruth Mortimer, BusinesWeek

http://brandstrategy.wordpress.com/2009/08/page/2/

My goal in this quest was to find an unusual type of cancer where all of you might say, “hey, what the heck is that?” and what I found was something that puzzles even oncologists.

Filed under the Universal category of “Hey, What the Heck is That?” is the Cancer of unknown primary site (CUP).

Taber’s 20^th edition Medical Encyclodedia tersely defines it as:

“Disseminated cancer in which the original tissue type is uncertain. Cancer of unknown primary site generally has a poor prognosis.” (Tabers 2005)

As Pat (my instructor) mentioned in class, identifying the primary site or origin of cancerous tissue is critical in order to diagnose and determine treatment methods and approaches for that particular cancer.  Just like finding treatment for any other disease, specificity is vital with cancers (remember culture and sensitivity?) The clock is ticking ever loudly with this difficult-to-ID cancer, as oncologists’ success rates are higher when they predetermine the type and origin of tumor the patient has.

According to the National Cancer Institute website:

“When the primary site cannot be identified, this disease may be called carcinoma of unknown primary (CUP). Most often, the metastatic cancer is first found in the lymph nodes, liver, lung, or bone.” (Cancer, 2004)

The article goes on to mention two important facets of identification: location of the spread and identifying tissue type found in cancer cells. If the spread of the metastatic cells is in the upper part of the body, the original cell is likely above the diaphragm (likely sites include the lung and breast); conversely, if the spread is noted in the lower part of the body, original site is likely below the diaphragm (such as the liver and pancreas). (Cancer, 2004)

Treatment options are largely governed by identifying the cancer, and ther  are a myriad of methods mentioned, but sometimes even advanced identification efforts fail. In the United States alone, 2% to 4% of all cancer patients are never diagnosed and suffer from CUP. The article ends with this not-so-cheerful thought:

“Still, when diagnostic tests have not identified the primary site, doctors must decide whether the potential benefits of more  extensive testing outweigh a patient’s discomfort and the financial costs.” (Cancer, 2004)

Final word:

(jd. disclaimer : small graphic picture of cancerous tissue below – proceed w/caution if you have a weak stomach)

Coming in at a close second in the ‘shocking cancers’ category was the ‘Chimney Sweeps’ cancer:  “cancer of the skin of the scrotum due to chronic irritation of coal soot”. (Tabers 2005)

I was hoping this cancer had died with the Industrial Revolution, but then I found this recent ad:

And this example of the disease: (tissue sample, cancer Scroti. )

Yes, this cancer is still around, and chimney sweeps today are routinely protected against and assessed for scrotal cancer.

It’s mostly a man’s crummy job, but I imagine if there are women chimney sweeps they are assessed for vulvar cancers. (Screening, 2004)   

SOURCES:

Taber’s cyclopedic medical dictionary – 20^th edition. 2005, F.A.Davis & Co. Phila, PA. USA.

Farmer, Pat, 2010 notes, HSU Nusing 306: Pathophysiology/Pharmacology. Retrieved from: lecture notes, presentation material from Cancer_1.ppt.

Cancer of Unknown Primary Origin, posted: 1/22/2004. National Cancer Institute Staff. Retrieved on 4/24/2010  from: http://www.cancer.gov/cancertopics/factsheet/Sites-Types/unknownprimary

Screening Recommendations for Professional Chimney Sweep. Bruce M. Gardner, MD. Posted: 02/27/2004. Retrieved on   4/24/2010 from: http://www.medscape.com/viewarticle/468905

"Stan's other Baby"

My patient Stan is at increased risk for Atherosclerosis.  This concerns me, as Atherosclerosis is one of the top fatal health conditions in America. He’s 55 years old, an avid car nut and family man.  He’s also a-pack-a-day since age 15 smoker and loves high fat greasy food (i.e. Polynesian BBQ, marinated Tri-tip, Jamaican Jerked Chicken…hello cholesterol!)

“So it’s been a while since you’ve come in…tell me how you’ve been doing.”

“Well JD, I don’t feel so well.  Whenever I walk my legs ache after about half an hour, and I have to rest to get the pain to subside.  I also get dizzy spells, and I have to sit down for those, too – and you know how much I love to sit – he he.” Smirked Stan.  I know he’s joking with me; he’s an active guy, always busy doing something.

“Tell me about your baby.”

“Miranda? Why she’s all growed up – I’m proud of her. You know, she’s going to school at Northwestern,” he says, sniffing back a tear.

“You must be proud Stan, you’re practically crying.”

“I am. I’m just sad thinking about ALL that money I’m gonna’ drop at Northwestern U.”

“Stan, that’s great, but I’m actually asking about your other baby in the parking lot there,” I said pointing to the late model Chevy in the parking lot.

His eyes light up. Suddenly, Stan’s a teenager again; eyebrows lifted and a smile draped across his face. “Oh! Oh Sheryl? Well, she’s running just fine.”

Stan’s other ‘baby’, the one he refers to as Sheryl, is his car.  A restored classic, 1967 Chevrolet Chevelle SS: mint condition, leather bucket seats, 4-speed, posi-traction rear, stock color GM gold flake.  It has the works.  Stan reworked the engine, 396 big block bored out to a 12:1 compression ratio – it’s a moderate but “street-legal racecar”.  Stan told me that with slick tires, it runs in the low 12’s on the drag strip.  Pretty damn good for a grandpa car.  I wanted Stan to think about that engine before I told him about his own internal engine – his heart and vasculature (i.e. arteries and veins) are clogged up by his 40 years of smoking and a fatty, greasy, grilled-animal-diet.  We’re going to have to discuss his numbers.

Me: “So Stan – I want to talk about your tests, but first, I want to ask you about your car’s engine – what happens to your engine if you use 20W-50 oil during the summer? Then say you neglected to change your oil, so it’s up to over 8,500 miles with the same heavyweight oil?  Let’s also say you haven’t had a radiator flush in 10,000 miles.  Tell me about the condition of that 396 c.i. engine out there under those conditions – just hypothetically, of course…”

Stan: “Well that particular oil is already real thick, so by now it would be sludgy – I’d get poor performance, the car would lurch and would accelerate more slowly, wouldn’t go nearly as fast as it could with lighter, thinner oil like 5W-30.  Old heavy oil is not efficient, not good at taking heat out of the engine, doesn’t circulate well…so it will overheat.  Might even clog up the valves, too.  Regarding that radiator, there’s a calcification that occurs on the inside of the engine block, the radiator tubing and radiator hoses if you don’t flush out that ol’ antifreeze.  Why, that might lead to a blocked radiator hose, which could stretch it out and blow a hole right through the wall of the hose.”

Me: “Alright Stan, your description of the engine is very much like what’s happening with your own heart and plumbing.  What’s happening is your blood is getting thicker; it’s not healthy, it’s like that heavy oil and thickened antifreeze fluids you described.  Looking at your INR-blood tests, and the other symptoms that brought you in today, we can see that you are at risk for getting a blood clot, which could blow a hole through one of your own pipes – the trouble is, that could cripple or kill you!  We need to make that blood thinner using a drug.  You’ve been using Aspirin, and that has helped, but we need to switch you to something more powerful, like Warfarin, commonly called Coumadin. Once you start taking this medicine, please stop taking the Aspirin; otherwise you might have problems with bleeding.  You also need to make significant diet changes – less salt, more vegetables, and get a walk in every day.  Smoking?  That’s gotta’ go.  It’s made a bad problem even worse.  If you want to be alive long enough to see your grandkids grow up, and be able to do more than watch them from your living room window, sitting in a wheelchair hooked to a respirator, you must stop smoking.”  I knew this last image of his inactivity would arrest his attention, knowing how active he is with his family.

“We have several options and even some drugs that can help wean you off the cigs for good, Stan.  Let’s start talking about that, as medicine can help you, but stopping smoking will really improve your health!”

Sources:

Lehne , Richard A., PhD (2007). Pharmacology for Nursing Care. Sixth Ed. USA: Saunders Elsevier Publ., St. Louis, MO.

(Bonus: see if you can find me in the program footage:)

http://kiem-tv.com/node/537

Shaun Case SN HSU

(translation: SN= Student Nurse)

I only had to wait a day to get my answer. According to news sources at Reuters and as reported by NPR the next day, “It later emerged that Wakefield had been taking money from a lawyer suing vaccine makers…” .  Baffled, I did more digging. It turns out a British investigative reporter for the Sunday Times, Brian Deer, has been tracking and covering this topic for years.

Following the money, what Mr. Deer discovered was that Dr. Wakefield initially took payments (from Richard Barr, Esq.) of over ₤55,000 ($85,000) to undertake the autism/MMR vaccine study.  Dr. Wakefield was then paid ₤150 ($234) per hour to conduct supporting research, resulting over the years in payments of over ₤430,000 ($670,000).  Why? Barr is an attorney attempting to construct an international class-action lawsuit on behalf of clients whose children have autism.  Barr could make a lot of money with this unfounded frivolous lawsuit, and he needed substantial evidence.

Mr. Deer’s site is an exhaustive link-citation to newspaper and journal articles from 2004-2010 on this issue.  A fine resource.

(Oh Jenny, how could you lie to me…not only is there no autism link, but lots of dirty money was involved…I’m so crushed!)