Up and Coming

Hello Redwood's Fans!

How was your Thanksgiving? Mine? Good. It was simple. My family and my parents. It was a joy to get to spend the day with them and not have to worry about going anywhere else.

Any Black Friday shoppers out there? Honestly, you will never see me get up early to go shopping. Even if offered a large sum of money. I. Don't. Do. Mornings. Plus, I really hate crowds and mall parking lots give me hives. This year I've done most of my shopping on-line. 

We're back to the medical mayhem this week!

Tuesday: What is the difference between the NICU and PICU? 

Thursday: Author question-- what's the best radiology study for a character experiencing headaches and blurred vision? Think you know the answer?

Have a great week and stay safe out there!!

Happy Thanksgiving!

Hello Redwood's Fans!

A simple post, a simple smile, and a hope that your Thanksgiving is full of blessings and no medical mayhem.

Happy Thanksgiving Week!

Taking a short blog break this week for Thanksgiving celebrations. I know this time of year can be stressful because of the following cartoon. Most law enforcement officers and healthcare providers know that violence increases over the holidays because people come together who normally don't and there is alcohol and financial pressure on top of it.

That is a powder keg.

So, I'd like to offer the following suggestions if you're feeling like you'd rather take that carving knife to a family member rather than the turkey on the table.

1. Join the Polar Bears and take a swim in freezing water. This will definitely cool you off.

2. Volunteer to feed the homeless. This puts things in perspective.

3. Go to Alaska and feed the bears-- it's far away, stunning scenery and you'll be so thankful if you live through the experience.

If those aren't an option-- watch a funny video and remember-- it's only a day. Or a few days.

Most importantly-- don't do anything that will land you in jail.

Blessings, Jordyn

P.S.-- There is some mild language in this video. You've been forewarned.

Author Beware: Arteries vs. Veins

Do any of you watch the chef Gordon Ramsey? He's a well-known British chef with a serious temper. It's been well displayed on many of his shows. At times, he just begins to bang his head on the counter at the incompetence of some of his chefs.

That's how I felt when I read this sentence in a manuscript.

"Her vein began to throb at her temple."

Perhaps, I shouldn't be so harsh. This person doesn't have a medical background and perhaps it isn't common knowledge that there is a big difference between arteries and veins.

There is.

Arteries carry blood away from your heart where it has just been oxygenated by your lungs. In order to carry the blood forward, the heart beats to propel it. Therefore, when an artery is severed, the blood spurts out with each heart beat in a fairly dramatic fashion. There is no question from the medical staff-- "Do you think he got an artery?" It more like, "We've got a bleeder!" The blood is a brighter red because it is loaded with oxygen.

Only arteries throb. That's how we feel your pulse-- at an artery.

Veins carry blood to your heart to get reoxygenated. They don't pulsate. The blood is darker in color and tends to ooze though if enough veins are severed-- the bleeding can be quite brisk.

The correct way to phrase the above sentence would have been:

"The artery at her temple began to throb."

And remember, all bleeding can lead to death if not controlled-- whether is be venous or arterial.

On the Fringe Of Medicine: Braxton DeGarmo, MD

Have you ever watched a TV show or movie, or finished a novel, and found yourself scratching your head at the end, wondering how that writer came up with such a lame idea? If the story was a medically or technology based one, there’s a good chance the writer was flirting with the edge of good science – not cutting-edge or state-of-the-art, but pseudo-science, fringe medicine, or, as some call it, deviant science – and fell off.

Now, I’m not talking about badly portrayed medicine. Television is full of that. I don’t think a week goes by without some character getting an injection into the neck or just above the elbow, neither of which is medically valid. Or what about those lead characters who get shot in the chest, just below the shoulder, and are back at work, busting the bad guys in a week, or less? Trust me, if you’re a writer, don’t use TV, or the movies, as your source of research. I’m sure you already know that.

I am talking about the actual science or medicine behind a story. Is it reality or something on the fringe of science? In medicine, that fringe is often called “alternative” medicine. Such practices as homeopathy and radionics (psionics or dowsing) fall into the “alternative” category, as does aromatherapy, the use of oils, much of herbal medicine, psychic healing, iridology, reflexology, cupping, and more. To date, these forms of therapy have not been scientifically proven and rely on anecdotal accounts of their benefits alone. Each subjective testimony is fraught with potential bias and error, and double-blind testing of such claims has typically failed to show any advantage. You never hear of the treatment failures, just the stories of those claiming positive results.

Please note that, in this post, I’m excluding “neo-traditional,” or ethno-medicine, which consists of traditional, culturally-based forms of treatment such as acupuncture. While these therapies cannot be explained scientifically, some of them have been shown to work and studies into why they work are on-going.

If you decide to include some form of “alternative” medicine in your story, don’t be surprised to find them explained in technical, scientific terms when you research them. Herbal medicine has renamed itself “naturopathy.” Radionics has its mysterious “black box” that looks like a scientific instrument. One of the trends in “alternative” medicine is to take on scientific trappings to make the modality seem legit and of proven benefit.

Mentioning a character’s use of one of these therapies as simply one more layer of her personality is unlikely to cause you problems. However, the risks of using “alternative” medicine in any significant way in a story are many. You must present it accurately, not just in scientific terms, but as its proponents present it. Even when you do so, you run the risk of alienating readers on both sides of that fence. Disbelieving readers might be turned off by its use, while advocates might get angry if it’s used negatively or presented as fraudulent.

And that gets to the crux of using fringe medicine, or science in general, in our writing. If it’s to be a major part of the story, you must make the idea believable. You, the writer, must get the reader to suspend his or her beliefs long enough to accept the premise. The further out on the fringe that therapy is, the harder that task becomes.

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Braxton DeGarmo, MD is a retired Emergency Medicine physician who lives outside St. Louis, MO with his wife and garden. He is the author of cutting-edge Christian fiction, whose titles include: The MilitantGenome, Indebted, Looks that Deceive,  Rescued and Remembered, and The Silenced Shooter. You can learn more about him at www.braxtondegarmo.com, or on Facebook at www.facebook.com/Braxton.DeGarmo.Author. He also tweets from @braxtondegarmo.

Up and Coming

Hello Redwood's Fans!

How has your fall been treating you? Anyone out there trying all the new pumpkin spiced products? Me . . . of course! Here's the rundown on what I've tried. Pumpkin Spice Oreo cookies. These were okay. I don't know that I would seek them out. Pumpkin spiced whipped peanut butter. Yes, you read that right. This was enjoyable but not sweet enough for me. Then there are the pumpkin spiced and pumpkin cheesecake donuts from Krispy Kreme.

So . . . the winner is . . . the pumpkin cheesecake donuts from Krispy Kreme!! They are yummy. And, I would like to publicly thank the woman who gave me the LAST pumpkin spiced donut of the day to try. I'd waited three weeks to stop by the store so you totally made my day!

What pumpkin spiced treat are you enjoying?

For you this week . . .

Tuesday: Author and ER physician Braxton DeGarmo stops by to discuss "fringe" medicine. Exactly what that is and what it means.

Thursday: Fellow writers . . . please . . . this is becoming very problematic. An author beware post on the difference between arteries and veins.

Have a great week!!

Dissociative Identity Disorder: Part 2/2

Today, author Robin E. Mason concludes her two part series on Dissociative Identity Disorder. You can find Part I here. 

The problem with DID is identifying it. Patients often live with DID for several years before they seek treatment. Even then, they may go through an extensive process of elimination before it is properly and correctly identified. The difficulty lies in that its symptoms are parallel to other mental and emotional disorders, and include:

•      Depression, suicidal tendencies
•        Mood swings
•        Flashbacks, memory problems, selective loss of memory
•      Insomnia, night terrors, sleep walking
•      Anxiety, panic attacks, phobias
•      Alchohol and drug abuse – it is interesting to note that DID is not cause by substance abuse, but may, in fact, trigger it.
•      Disorientation and confusion
•      Compulsions and rituals – OCD behavior
•          Auditory and visual hallucinations
•       Eating disorders

Perhaps the hallmark symptom of DID is its fugue states: periods of time, from minutes to days, in which an individual has no memory of events, or of time itself.  Different personalities, or alters, will surface in specific circumstances. Each alter splinters off for that purpose, to cope with various life events. The consensus theory on the cause of DID is extreme childhood trauma, usually associated with sexual abuse. Triggers can be a visual setting, a voice, photo, food – any stimuli that brings unwanted memories to surface. It is at this point an alter steps in to cover for the host or primary personality. Typically the host has no memory of what his or her alter does. Alter personalities, however, mostly are aware of other alters and their actions.

Treatment for DID is found through long-term psychotherapy, hypnotherapy, and/or art, music or movement therapies. The objective, of course, is to integrate the alters into a singular and whole – multidimensional - person.  As DID is not physiologically induced, there is no medication to treat it. However, accompanying disorders like depression or anxiety may be treated with medication and thus alleviate some of the DID symptoms or triggers.

There is some school of thought that DID is not legitimate, but is iatrogenic, or that it is created by suggestion of the therapist. However, brain imaging studies have provided evidence of physiological changes in some patients.

As for Sybil, some question arose at the authenticity of her diagnosis. Dr. Wilbur was accused of falsifying her findings. At one point, Sybil, whose real name was Shirley Mason, admitted to making the whole thing up. She later recanted that admission.

It seems to me that whatever Dr. Wilbur’s motivations were, Sybil’s story was not entirely untrue If, on one extreme, the whole thing was the wild creation of her and Dr. Wilbur, that speaks of something horribly wrong – which would then be another issue and sickness. We will never know if what happened in her childhood triggered panic attacks and black-outs. I believe there was truth in her story, 10% or 100%, I can’t say. I believe it stirred an interest in the condition, and in turn childhood abuse.

Previously, I said I learned why Sybil’s story intrigued me. Not because of sexual molestation, because I wasn’t. And not because I ever suffered DID, because I haven’t. But something about her dark childhood rang true with me, however different that might have been. I felt that I was in a dark hole, unwanted, unwelcome, and unloved. In that, I can identify with Sybil. And in that, my fascination with DID and crises of identity. I know now, too, that I am whole, I am wanted, and I am loved.

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Robin Mason lives in upstate South Carolina where she began writing as self-proscribed therapy in 1995. Life threw a few (dozen) (thousand) hiccups and curve balls, and she got serious about working on her debut novel, Tessa, in 2013. Robin’s greatest priority and highest calling is to honor God in all she does, especially with the talents and abilities He’s given her. Like writing.

Dissociative Identity Disorder: Part 1/2

I'm pleased to host author Robin E. Mason on Redwood's Medical Edge who will be guest blogging in two parts on Dissociative Identity Disorder AKA Multiple Personality Disorder.

Welcome, Robin!

I was first intrigued with this phenomenon, then called Multiple Personality Disorder, when the movie Sybil starring Sally Field came out in 1976. At the time, I couldn’t have said what about it so intrigued me. I would only learn the reason years later.

As with any phenomenon, I believe there is nothing new under the sun, only our awareness of it. Sure, epidemic waves run their course, and then there may be little or no action for a time and then – BAM it strikes again.

The National Alliance on Mental Illness defines Dissociative Identity Disorder (DID) as involving a disturbance of identity in which two or more separate and distinct personality states (or identities) control an individual’s behavior at different times. They further state that each identity, or alter, may exhibit differences in speech, mannerisms, attitudes, thoughts and gender orientation… even present physical differences, such as allergies, right-or-left handedness or the need for eyeglass prescriptions. Psychology Today states it this way, failure to integrate various aspects of identity, memory and consciousness in a single multidimensional self.

We all have different and varying roles in our lives – multidimensional selves - and we continually switch back and forth. The difference is, I am fully aware when I am being my writer-self – like right now – and when I must (force myself to) be my homemaker-self, i.e. vacuum and do the dishes. I delight in my granny role, and fully enjoy activities with my granddaughters. Still, all is done fully aware of my different roles, and all are done with the same basic personality traits. I have more fun with it that perhaps most people, though, because I am also an actress, and will switch accents on a whim. Yeah, I do that!

Double consciousness, or dédoublement, the historical precursor to DID surfaced in the 19th century, which was observed as sleepwalking. Hypotheses claimed this to be switching between a normal consciousness and a somnambulistic state. (Wikipedia)

The problem with DID is identifying it . . . 

Come back Thursday for Part II. 

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Robin Mason lives in upstate South Carolina where she began writing as self-proscribed therapy in 1995. Life threw a few (dozen) (thousand) hiccups and curve balls, and she got serious about working on her debut novel, Tessa, in 2013. Robin’s greatest priority and highest calling is to honor God in all she does, especially with the talents and abilities He’s given her. Like writing.

Up and Coming

Hello Redwood's Fans!

How has your week been?

Mine-- getting back into the swing of life. The holidays are upon us and I'm seriously going to get my Christmas shopping done early this year. I mean, everything wrapped and under the tree by December 1st.

Don't hate me.

I'm usually not so far ahead of things but I find that once these are done-- I can focus just on friends, family and Christ.

This week, friend and author Robin E. Mason is stopping by to talk about Dissociative Identity Disorder. She presents some really interesting information and I hope you'll check out her new novel, Tessa.

Have a great week!

Right to Die: Should It Be Legal?

Recently, two cases involving the "right to die" have been in the news. One more so than the other.

The first is the case of twenty-nine-year-old Brittany Maynard. Sadly, Brittany was diagnosed with an aggressive form of brain cancer. She attempted surgery which did remove most of the tumor but it grew back in a period of two months. At that point, she declined further treatment, to live her last days to the fullest.

With one caveat. She wanted to choose the method and time of her death.

Her family intentionally moved to Oregon which in 1997 enacted the Death with Dignity Act which allows physicians to prescribe lethal medications expressly for the purpose of ending one's life.
 

Which she did on November 1, 2014.

The second case is of Nancy Fitzmaurice, age 12, whose mother petitioned the court in the UK and won the right to let her daughter die by withdrawing food and fluids. It took 14 days. Sometimes I have trouble knowing for sure if things reported in England papers are true because I don't know what reliable sources are "over the pond" so take this with a grain of salt. I researched Snopes and didn't find it listed there as false.

Here is my take.

Case One:

Though sad, Brittany is an adult with a diagnosed terminal condition. Though I think every moment of life is precious and wouldn't choose this for myself, I support her right as an adult to do this. I think the right to die should be severely limited to cases like Brittany's and not be used for things like depression, mental illness and most chronic conditions. I'm not an expert on the Oregon law but I think two independent physicians should certify that the patient does have a terminal condition that will lead to death.

Case Two:

This case, if true, I am wholly against. First of all, food and water is a basic need. Allowing her to die by withdrawing food and fluid was torture. I'm sorry but it's true. You can't even do that to an animal without being put in jail. But-- is that the only way it's "appetizing" to the public? Honestly, actively taking her life would have been more humane. I think if this family could not emotionally, physically, or financially take care of her anymore than other alternatives should have been considered. She was a minor. She was disabled. These are who we are called to care for.

What say you?

Ebola: Is it Airborne?

I'm just not convinced it can be wholly said that there should be no concern that Ebola cannot be transmitted through the air.

Even if Ebola Zaire, which is the strain responsible for the current outbreak in West Africa (and is also the most virulent with up to a 90% kill rate) is not airborne-- I'd like to highlight the discovery of Ebola Reston as thoroughly discussed in Richard Preston's nonfiction title The Hot Zone which presents case studies of four Ebola viruses (Marburg, Ebola Sudan, Ebola Zaire and Ebola Reston.) It is a must read.

First of all, these viruses are relatively new. They first showed up in the 1970's literally out of nowhere. Why do I say that? Because the reservoir for these viruses has never been found. No one knows where it comes from or what plant, insect, or animal it might live in without killing it. It is thought that Kitum Cave in Mount Elgon National Park is a likely candidate but testing of several species within the cave haven't found the host. 

Ebola is a filovirus or thread virus. It has a distinctive look under microscope resembling a jumbled mass of tangled threads with eyelets or shepherd's hooks on the end. There are currently five species of Ebola virus: Zaire, Bundibugyo, Sudan, Reston and Tai Forest. All have varying degrees of virulence.

To learn how Ebola kills-- check out this video. 

Let's get back to Ebola Reston. This strain of Ebola was first discovered in a monkey house in Reston, VA in 1989. This facility housed monkeys from overseas for several months to prove they were healthy before being sold to research facilities. 

There were several different rooms to this monkey house but the facility did share one ventilation system. An illness began to break out among the monkeys that killed them swiftly. The animals would lose their appetite, develop a mask-like quality to their face, become inactive and die within one to two days. At times, they had bleeding from their noses. Necropsy done by an employee of the facility showed large, hardened spleens and evidence of internal bleeding. 

This employee decided to send samples to the United States Army Medical Research Institute of Infectious Diseases (USAMRIID) which was nearby and after testing over days and weeks-- it was discovered that this was a new strain of Ebola. At that particular time, only Ebola Sudan and Ebola Zaire were known.

The interesting thing about Ebola Reston is that it is airborne. It traveled through that monkey house, room to room, and began killing animals that hadn't had any direct contact with one another. It was so concerning to the Army because of the facility's location to Washington D.C. that a decision was made to "nuke" the entire animal population and gas the building to kill every microscopic living thing inside. This led to hundreds of animals being euthanized.

Then, it happened again. More animals were brought in from overseas and the virus went loose. Likely, the animals brought it with them and it was not present in the facility. 

On autopsy of these monkeys, it can be seen that the virus was located in their lungs-- ready to burst from air sacs. This is how airborne transmission works. The virus is coughed up and expelled into the air where another person breathes it in. 

When the second incident of Ebola Reston hit the monkey house-- they let it run its "natural course" since they had also discovered it didn't cause illness in humans. When they did that-- 100% of the monkeys died. 

What's interesting about the Reston, VA monkey house workers was that they all seroconverted from the illness. This means they were infected, their body built up antibodies, but they didn't get sick. What's scary is that genetically speaking-- researchers don't really know what makes Ebola Reston all that different from Ebola Zaire. The question becomes . . . how easy would it be for these other Ebola viruses that do cause serious illness in humans to change one protein structure to then be airborne like Ebola Reston?

The answer is . . . they don't know. What they do call Ebola in general-- a slate wiper. People who know a lot about Ebola lose sleep over this virus. 

Personally, as a healthcare provider, I think it's safest to operate under the assumption that it has the potential for airborne spread. We should be using the same level of protection when working with this virus that the US Army does-- which they classify as a Level 4 Hot Agent. You wear a space suit working with these pathogens. People who work with Level 4 Agents are viewed as a little crazy according to Preston's book. 

I don't think we respect this virus enough. Here in the US-- people are very blase about its potential to kill. Keep in mind that those that survived here were treated early by a highly specialized medical system and received experimental treatments that likely helped them fight off the virus. 

As for me caring for patients-- I'd like a spacesuit, too. What you see is what I get. 

Would you consider this adequate?

Up and Coming

Hello Redwood's Fans!

What an interesting week it has been-- medically speaking. Lots of medical things in the news. I tried to tune it all out while I was on my writing retreat (of which, I did get a lot of writing done!) but quickly was inundated with medical stories upon my return and my inner medical nerd couldn't help but start doing more research.

Plus, I had to go to my hospital for mandatory Ebola training-- like two days after my lake retreat. It's hard to go from the first photo to the second photo. Reality can hit hard sometimes.

This week, I'm focusing on some of these interesting medical cases that could easily be worked into a fiction novel.

Tuesday: Can we say for sure Ebola is not airborne? I'll give you my take tomorrow.

Thursday: The Right to Die? Should it be allowed? If so, under what circumstances?

Have a great week.