Comments by "pugetwitch" (@Pugetwitch) on "Peter Santenello"
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Addressing the unauthorized landing of United States troops in the capital city of the Hawaiian Kingdom, President Cleveland stated, “on the 16th day of January, 1893, between four and five o’clock in the afternoon, a detachment of marines from the United States steamer Boston, with two pieces of artillery, landed at Honolulu. The men, upwards of 160 in all, were supplied with double cartridge belts filled with ammunition and with haversacks and canteens, and were accompanied by a hospital corps with stretchers and medical supplies (p. 451).”
President Cleveland ascertained that this “military demonstration upon the soil of Honolulu was of itself an act of war, unless made either with the consent of the Government of Hawaii or for the bona fide purpose of protecting the imperiled lives and property of citizens of the United States. But there is no pretense of any such consent on the part of the Government of the Queen, which at that time was undisputed and was both the de facto and the de jure government. In point of fact the existing government instead of requesting the presence of an armed force protested against it (p. 451).” He then stated, “a candid and thorough examination of the facts will force the conviction that the provisional government owes its existence to an armed invasion by the United States (p. 454).”
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@IRailroad can cause toxic leukoencephalopathy from that. "Leukoencephalopathy refers to inflammation and damage to the brain's white matter-;the network of nerve fibres that enable the exchange of information and communication between different areas of the brain's grey matter.
Toxic leukoencephalopathy is a sudden or longstanding neurological syndrome, which has been reported after heroin inhalation, known as 'chasing the dragon'. But this is the first reported case associated with fentanyl, say the report authors.
The condition is manifest in various signs and symptoms, the most obvious of which are neurological and behavioral changes, ranging from mild confusion to stupor, coma, and death.
The outlook for those affected generally depends on the extent of white matter injury, explain the report authors: some people will recover fully; others will progressively get worse.
In this case, the man had no previous medical problems of any note, and had been unconscious for an unknown period of time in his hotel room, where unidentified crushed pills and a white residue were found on a nearby table.
On arrival at hospital, he wasn't able to answer questions or follow commands. He responded to pain stimuli to his legs, but not his arms.
A brain scan revealed white matter inflammation and swelling and cerebellar injury. The cerebellum is the part of the brain responsible for gait and balance. He tested negative for epilepsy.
drug screen returned negative results, but a separate urine test indicated a very high level of fentanyl, prompting a diagnosis of toxic leukoencephalopathy induced by fentanyl inhalation.
Eighteen days later, he remained bedbound and still required tube feeding. He was given several different drugs to treat urinary incontinence, kidney injury, cognitive impairment, suspected opioid withdrawal, pain and agitation, and pneumonia.
After 26 days he was discharged to a rehabilitation facility, and after another month returned home with the support of outpatient physiotherapy and occupational therapy.
Less than a year after his hospital admission he had fully recovered and had returned to work full time.
Commenting on the incident, he describes his recovery as "miraculous", adding: "Early on it was looking like I would need 24 hour care after being discharged, but I focused and worked hard in my therapy session and was determined not to leave the hospital only to be checked into a group facility for ongoing care."
Expressing gratitude to all the healthcare professionals who not only saved his life, but enabled him to get back to the life he had before, he says: "I have regrets often about what I did to myself, my wife, and my family."
The report authors conclude: "This case illustrates the need for inclusion of fentanyl in routine urine drug screens for earlier identification and appropriate management."
Journal reference:
Eden, C. O., et al. (2024). Clinical and neuroradiographic features of fentanyl inhalation-induced leukoencephalopathy. BMJ Case Reports.
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