Comments by "Stephen Villano" (@spvillano) on "Institute of Human Anatomy"
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One thing in common with influenza and COVID is, both utilized the same general method of infection, via different receptors.
Both invaded phagocytes, essentially infecting the very alert and first response system of the immune system. Both resulted in eventual cytokine storms that were triggered essentially by the body "noticing" that the infection wasn't being properly addressed and switching to a cytokine storm based "scorched earth" attack on the infected cells, which by then were fairly ubiquitous and beyond just phagocytes.
Initially missed, in part due to some faulty reporting, cytokine storms were initially denied and hence, went unaddressed, causing the worst and most lethal of the infection's symptoms. Once realized, the storms were blunted with steroids and that became the first route of intervention.
In the 1918 influenza pandemic, the mere existence of the virus was theorized and considered a wild theory that had absolutely no evidence in support of it. Cytokines were utterly unknown. We'd barely managed to develop vaccines against h. influenzae, a bacterial infection and those were actually developed in some physicians own personal laboratories! One researcher that was well respected had authored a paper proclaiming h. influenzae was the cause of the 1918 pandemic, which lead many researchers down the merry path to nowhere, but it wouldn't have helped had they been aware of the actual cause, as viral research didn't exist, there was no way to visualize the virus, no means of comprehending viral replication, it wasn't until 1931 that the electron microscope was invented, It wasn't until 1933 that influenza A was finally isolated from swine!
So close, yet so far!
Interestingly, in 1910, Dr Wu Lien-teh had been dispatched to manage and treat an outbreak of pneumonic plague in Manchuria and Mongolia, which ultimately claimed 60000 lives. He'd performed, unusual at the time and location, an autopsy and ascertained that it was indeed airborne and developed a filter mask, the first in use to prevent infection of its kind, which was highly successful. A French physician was dispatched to replace him and refused to use the mask, compounding that with some ethnic slurs and died within days of pneumonic plague. The doctor then insisted upon cremation of the bodies to halt the plague's spread, which was adopted and the plague swiftly ended. It took quite a lot of additional time to eventually trace the animal vector of the infection.
Reports of his filter mask were widely distributed and by the 1918 influenza pandemic, were well known and most of the arguments against surrounding COVID and masking, well heard and disproved at that time, with liberty and freedom arguments, etc long exhausted and well, a hell of a lot of folks just went with masking and kept doing that not dying thing. Yet, we still managed to turn an argument over well established medical science on filtering droplets out with a simple mask into a political argument, to the detriment of all.
But, it's been said, the two most common things in the universe are hydrogen and stupidity.
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Pheochromocytoma is usually found inside or on the adrenal gland(s), but occasionally, one will be present pretty much anywhere in the body and flood the body with adrenal hormones, such as adrenaline.
Yeah, things can get lost and set up shop in the wrong place or a mutation causes a tumor that produces things it shouldn't in the wrong place.
Or in my case, I've long had a mass on my adrenal gland that does nothing whatsoever, so, no harm, no foul, leave the dog alone. ;)
Meanwhile, my immune system took a dislike to my TSH receptors in my thyroid gland, turning it on full tilt. Hypertension, tachycardia, extreme rapid weight loss, Hulk level "irritability", heart failure, abdominal aortic aneurysm all came to visit. The last time I had a thyroid storm, it was right at the first peak of COVID and my pulse oximeter read 85, well, that and I was gasping like a fish out of water, convincing me to have my wife call an ambulance (I hate hospitals, they're full of sick people!).
Doctor came in after testing and said, "I have good news, you don't have COVID".
"Oh? What do I have then?"
"A type of heart failure from your hyperthyroidism."
"Oh, thank God it's only heart failure... <blink> Did I just say those words?"
Doctor laughed with a bit of a hysterical tinge, "Yeah, but I understand".
At the time, hospital beds lined the hallways and were double stacked in the elevator lobbies, with one floor overflowing with COVID patients.
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The bear of it is, fresh water drowning is actually easier on the body when recovering. Fresh water is hypotonic, so gets absorbed by the tissues and diffused into the bloodstream. Salt water is isotonic and harder to absorb.
Had the same training as he did. First, pause for a moment to clear the "holy shit" factor, failure to do so can get you killed.
Orient to the seat, I used the seat back. Once grasped, don't release and release the harness. Feel for exit, in that case, the emergency exit windows. Remember the entire time that you float naturally, jettison crap that'll weight you down before moving.
I also have a trick that usually works, exhaling a little into my hands, feel which way the bubbles are going, that's up.
Once one breaks the surface, give thanks for gravity. You're kind of screwed if you're submerged in microgravity.
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@miah5040 yeah, as an Army medic, I've had to administer morphine, then clean the vomit from my boots.
If that was the worst that got on my that day, it was a slow day.
Wouldn't have minded getting amniotic fluid on me, I'd have been helping deliver an infant.
Instead, I was half-expecting to next get hemolymph on me and have to get on the radio and declare, "Zed, we have a bug"...
Yeah, we develop a bit of an interesting sense of humor in EMS, especially military EMS.
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I had discomfort, with burning at times, right in the area consistent with gallbladder obstruction from stones. An ultrasound verified an assortment of large economy size stones and the gallbladder and stones removed, the common bile duct verified as clear.
Still had the discomfort, which eventually turned out to be from oddly referenced GERD symptoms. :/
A decade and change later, one night, I had severe pain in the solar plexus region, with rebound in the right quadrant, severe nausea, was soaked with sweat and spiking a mild fever. An episode of vomiting resulted in a sensation of something solid impacting my lower stomach and the symptoms resolved.
Everything consistent with obstruction at the sphincter of Oddi, which is where the common bile duct empties into the stomach. Interestingly, the press reported that Ruth Bader-Ginsburg had a stent in that very location.
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Then, there's HHV-3, varicella. Aka, chickenpox/shingles.
Thankfully, declining as use of the vaccine expands in the covered population. Our kids helped test the vaccine candidate. One, apparently receiving a placebo, as she later contracted the virus some years later.
Had it as a kid, pure misery. Had a 1 cm lesion of shingles as an adult, miserable enough, but could've been worse, as I've seen peers with worse cases. Got the shot as soon as I could!
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Hopefully soon, you'll make an episode on our "second brain", aka the enteric nervous system.
Amazing how many functions are managed so well by so few cells!
Oh, one other malfunction moment, moderate to severe diarrhea. Had an episode strike right after rest rooms reopened during the first spring wave of COVID, where by the time I got to the necessary in the store, well, that toilet area needed some very serious cleaning - despite my efforts to lower that requirement. I did, of course, report it to the store manager and apologized for the god awful mess.
Absolutely zero control once I began to sit down. Never did figure out what so irritated my bowel so greatly. :/
Oh, emergency field hydration, when one is out of IV catheter insertion units or even plain large bore needles, one can use just the tubing (lubricated, of course) rectally and the colon will scavenge the fluid and rehydrate the patient.
Given the choice of rectal rehydration and an intraosseous device, yeah, I'll take the lesser invasive method when AAOx3!
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I asked doctor for a prescription for 600 mg ibuprofen, typically for once a day. Doctor revolted, exclaiming, "Do you know what that can do to your kidneys?!".
I replied, well, most other drugs go through the liver, inflicting their own havoc in your extreme view and I have hepatitis A damage, as well as heat stroke damage to my kidneys (trace of protein) and liver, so instead, how about an opioid?
Got my ibuprofen, 30 day supply lasted a year.
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@alhoonxor on a steroid now, just as I was when I got COVID, which was blunted by the vaccine, so only had mitral valve damage. Now, on the steroid due to recently being diagnosed with Crohn's disease.
Downside being, now I've gone at age 63 from pre-diabetic to diabetic while on the steroids. Start my biological to wrangle the immune dysfunction that's causing Crohn's at the end of the week and the research suggests the steroid and biological together speed remission slightly and recovery significantly and rapidly.
And my immune system lends strength to flagging oxen.
And once the biological initiation is done, the steroid will be tapered off and I'll go back to pissing off every one of my paternal cousins and remaining aunts and uncles, as by they reach mid 30's to 40 at the latest, they're universally diabetic. I've only recently reached pre-diabetic. All because I eat a balanced diet, rarely eat heavily processed foods, keep my weight under control and stay physically and mentally active.
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I tend to naturally do the Rice Krispies snap, crackle and pop as a matter of course.
And haven't been able to hold a stethoscope with my fingers for decades, due to crepitus being thunderously loud. Gotta palm it.
The price I pay for skipping lube and oil changes...
I started out with hypermobility of a moderate degree. Occasionally, my fingers will actually lock in a hyperextended position, where the adductors cannot bend the joint, as it's beyond what's considered the normal range of motion, so any pulling slightly adducts them. Annoying, I actually have to do some maneuvers to release things enough for the joint to function properly, either some maneuvers to lower the leverage or manually bring the joint where it can function again. After all, joints, especially fingers are levers and pulleys that are actuated by muscles. So, a finger with its second joint bent past a critical point won't be able to return to a normal position unassisted.
Downside of hypermobility with age, lowered mobility and increased injury rates, when one's accustomed hypermobility fails. :/
No worries though, I'm signed up for a full body transplant. Alas, they keep trying to pawn one off on me with a brain...
Oh, cavitation bubbles usually don't pop, then implode and a bit of trivia, frequently will actually emit a flash of light. They're still trying to explain the flash of light.
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@ReasonablySpeaking9808 I have a benign mass on one adrenal, so it's just a keep an eye on it if it gets captured in any imagery. The thyroid, options were either radioiodine or medication, medication being selected so I've been taking methimazole twice per day (only really need to take both pills once, but I prefer balancing how many pills to take at a time, so twice per day, since I have to take my beta blocker twice per day).
The pheochromocytoma was in two patients I worked with in the military, the first was expired on the scene from a ruptured abdominal aorta. Basically, once that aorta let go, there was no chance and essentially she was dead before she could literally fall off of the log she was sitting on. The other, successfully treated surgically, it only came up when I was taking his medical history.
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I've had posterior nosebleeds my entire life. Mostly, it seems to be triggered by dry heat during winter, with some joys in early spring with a bit of swelling from pollen.
Losing a unit of blood isn't uncommon and I've taken to largely just let it bleed for 10 minutes or so max into a sink or toilet, was out of toilet paper in the bathroom and the damned room literally looked like a murder scene.
Cautery? Tried repeatedly. Packing? Tried repeatedly. Medications? Doctor even tried vitamin K, which I'll admit was a Hail Mary play.
Back during the first April wave of a certain pandemic, I was hospitalized with initially presumptive COVID-19, proved later to be what I suspected, thyrotoxicosis. Literally, the low O2 saturation was due to a hypertensive crisis and some LVH (saw that on the ECG in the ED and was swearing a blue streak). On 5 - 7 LPM O2 via nasal cannula, when I saw bright red spotting, got the dose lowered without SPO2 dropping and a humidifier installed on the O2 feed.
Those nurses didn't need a bleed like that and deal with a smattering of complex COVID cases!
Entertaining was when the endocrinologist suggested that if the methimazole didn't control the thyroid output in a timely manner, iodine administration was her next course. She was shocked when I mentioned the Wolff-Chaikoff effect...
Some of us got just a lot more training and experience in military medicine than most. I've never declined training and never will!
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I dunno, I've said repeat a few times over the radio. The indirect fire eventually makes an impression. ;)
I tend to prefer to refer to explosions visual and audible effects as "thunder, fire and brimstone". It gets the point across reasonably well.
Hmmm, ignored by Hollywood? Blast cavitation injuries, avulsions from the same, hollow organ ruptures, shrapnel injuries (even on the rare occasions they hint at it, it's tiny wounds, not missing limbs, half of a head, seeing through a thorax, evisceration... Then, there's shake and bake, Willie Pete and HE quick, everyone will try to bunker in for HE, but when WP comes to visit, try to keep up with the old SOB!
Movies and bullets, a bullet hits, it always goes straight. It also always has to come out to fix a problem, which is bogus, as anything needing the bullet removed also means repairing blood vessels and bones, otherwise, if it isn't damaging anything, leave it the hell alone and not injure the patient even more.
Circling back to explosions, MASH did one scene well. Hawkeye was operating on a patient with a bone jutting from his body. He remarked, "Well, he doesn't need this", a nurse queried if the damage was that severe or something similar, he remarked, "No, it's not even his". Someone stepped on an antitank mine and one of his bones from his leg impaled the patient. It was a true story.
Or the Afghanistan case, where an RPG round was impaling a patient. The surgeon evacuated the OR, only volunteers worked on him to remove the round from his body, just in case it detonated and killed everyone present.
Next, in military situations, an explosion sends all manner of shrapnel, both from the device and whatever is nearby. Service member gets some of the shrapnel, but escapes significant injury from the blast itself. Fortunately, his body armor prevented any penetrating injuries, the ESAPI plates did need replacement and the fractures beneath were treated and healed uneventufully. Rib fractures suck, but sucking chest wounds suck even more.
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Kidneys, complicated, only seconded by the colon. Otherwise, we'd be mummies. And sex would become incredibly, erm, dry.
I do have a bit of protein leakage from the kidneys, courtesy of a heat stroke.
Doctor worries about kidney function, I concern myself with body fat and insulin resistance, due to familial trait.
All cousins remain diabetic, I'm refraining from that and grasping at age 62. Working on the rest.
Hypertension and whatnot, yeah, a big deal. That whole aortic abdominal aneurysm is a thing.
Doctor's fondest advice, "See you next year".
Kidneys and liver, my fondest organs. They do the most work of the body, outside of that parasite, the brain.
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I remember the nitrogen levels and protein becoming a major legal and public health matter and scandal in 2008.
Milk collection locations at the time were entirely unsupervised by the PRC government and to boost product output as demand increased, unscrupulous management directed the milk be diluted and melamine added to boost nitrogen content, which would fool protein level testing.
The problem being, melamine breaks down in a way to produce kidney stones, in this case, large, destructive kidney stones and oh yeah, a lot of that milk went into baby formula.
"On 1 December, Xinhua reported that the Ministry of Health revised the number of victims to more than 290,000 with 51,900 hospitalized; authorities acknowledged receiving reports of 11 suspected deaths from melamine contaminated powdered milk from provinces, but officially confirmed three deaths." That's just in China, the milk was also exported and true numbers difficult to find, as it went to many developing nations. Many of the children require dialysis to survive.
17 went on trial over it, with one life sentence, two executed, the rest getting 19 years, commuted to 15 years and change.
For those unfamiliar with melamine, it's used as a fire suppressant, in making plastic dinnerware (I ate from melamine plates as a kid), dry erase boards and more. Note how it's not used as a food ingredient. It's not soluble in water, so they had to add another chemical, such as formaldehyde to it (in low quantities, still not a biggie, the body makes that as well whenever it's making DNA) and they added maltodextrin, a carbohydrate to emulate milk sugar.
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Not quite true, in nature there are a couple of examples.
Massospora cicadina, cicada abdomens completely consumed, spread by mating attempts. Toxoplasma gondii removes fear from predators from mice permanently, resulting in predator success and successful infection of the predator, spreading cysts throughout the environment to infect more mice, completing the reproductive cycle of the parasite.
As for actual living dead, remember that morning after the holiday weekend? ;)
Still, research has found that some brain cells, thoroughly disorganized, survive for days, expiring along the way, but all of the neural networks were destroyed by hypoxia and hence, we're talking ones and twos in diffuse regions, incapable of processing anything.
But, useful for statistics to chew on.
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