Up and Coming

Hello Redwood's Fans!

You're going to have to forgive any grammatical areas as I'm likely brain fried from editing ALL week and running my first 5K. Really, keep the liquor locked up. I have to stay bright eyed until at least May 20th. Then . . . well, who knows!

Congratulations goes to Patti Shene for winning a copy of Dr. Mabry's Stress Test!!

For you this week:

Monday: Dianna Benson stops in for another fictional (though medically accurate) first person account of taking care of someone who has been involved in a MVC. I love the way she writes these posts as not only are they really informational but educational as well.

Wednesday and Friday: So pleased to host author and double Christy Award finalist, Jocelyn Green, who is talking about the medical research involved with her latest novel, Widow of Gettysburg. She's also offering a chance to win this amazing book so check out her posts for further information.

Have a great week.

Back to editing.

Someone. Send. Help.

Author Question: Disease for Infant

My good friend, Candace Calvert, drops by today with a medical question. Even though she is a former ER nurse extraordinaire-- pediatrics was not her specialty so she is doing what medical people do best-- consult an expert and I am happy to help out with the help of one of my physicians.

Candace writes inspirational romance with a medical backdrop. I happily endorsed, Rescue Team, releasing May 1st which is book #2 in the Grace Medical Series. Hope you'll check out all of her books. She is one talented lady.

Candace Asks:

I need a disease/disorder for a 6 month old baby that would require hospitalization and is hereditary.

Jordyn Says:

Okay, first I have to confess that I got the answer to this question from a physician co-worker who is an encyclopedia for crazy medical conditions. If your child is that zebra in the forest, she will figure out what it is so thanks Cathy for this answer.

A perfect condition would be a Fatty Acid Oxidative Disorder. In this case, a long chain mixed fatty acid oxidase deficiency. Now, before your eyes glaze over with that-- I could never write that-- checked out look like I may have had in high school algebra you could simply say the child had an inherited metabolic disorder.

The child would appear to be normal and all body symptoms normally functioning until something happens to cause the child to fast such as stomach flu (gastroenteritis) that would cause the child to stop eating due to vomiting.

This definition comes from the follow link:

Definition: Fatty acid oxidation disorders are inherited conditions that affect the way a person’s body breaks down certain fats (fatty acids). A person with a fatty acid oxidation disorder cannot breakdown their stored fat for energy. Consequently, the body begins to fail once food the person has eaten runs out. In addition, fatty acids build up in the blood. In the case of fatty acid oxidation disorders, the inability to break down fats for energy and the build up of fatty acids can cause serious health problems.

In a normal, functioning body, when you no longer are taking in food, your body starts to metabolize muscle and fat for energy. This is actually the basis of some diets that cut out carbs in order to get you to burn fat. It puts your body in a state of "ketosis" which isn't necessarily an awesome thing-- but I digress.

When the body is burning muscle and fat for energy, you get a build-up of ketones in the blood. We can actually see the body is burning ketones by performing a urinalysis that shows ketones.

In this case, what would actually point the physician to think about this particular metabolic disorder is the absence of ketones in a state where the patient would normally be ketotic. For instance, the blood sugar would be dangerously low (10-20-- where you could actually seize.) Normal blood sugar is 60-100. When the blood sugar is low, the body should naturally go to protein (muscle) and fat for energy because it is very self serving in wanting to stay alive. On the urinalysis, there would be absence of ketones showing the body's inability to breakdown these tissues.

Treatment would include infusing a high sugar solution (like D10).

Epidurals: The Good, The Bad, and The Ugly

I'm pleased to host anesthesiologist and suspense author, H.S. Clark, as he discusses his thoughts on epidurals. Very informative post. I hope you'll check out his medical thriller Secret Thoughts available on Amazon. 

On the morning on April 7, 1853, a little known innovative physician, Dr. John Snow, was called to Buckingham Palace to administer Chloroform anesthesia to Queen Victoria for the birth of her fourth child, Prince Leopold. The Prince was healthy, and the Queen did not feel the pain of childbirth. That was the beginning of the end for “natural” childbirth, and the dawn of modern anesthesia for labor and delivery.

Buckingham Palace

Now, 25% of mothers give birth by Caesarian section, and 75% of the remaining vaginal births receive either a spinal or epidural anesthetic, so that leaves less than 20% to experience “natural” childbirth. We know now that the designation “natural” does not mean medically superior. The pain and stress of labor and delivery raises maternal blood pressure, increases circulating adrenaline, impairs breathing, and interferes with muscle control and fetal descent, all to the detriment of both mom and her unborn baby. Pain also leads to expulsive deliveries that increase the occurrence and severity of pelvic lacerations.

We’ve now progressed from Chloroform to the use of epidural anesthesia. Small amounts of local anesthetic placed in the lower back near the spinal nerves set up a regional block of the bottom half of the body. It’s like two cops stopping all the highway traffic with a roadblock. Modern epidural anesthesia reduces stress for mom and baby, which is especially helpful if the baby is medically compromised. Epidurals are used not just for pain control, but also as an active tool to manage labor and delivery, and to provide flexible options, safety, and control that is not possible during “natural” childbirth. Unlike the early days of epidural anesthesia, modern epidural methods do not slow labor, have minimal effects on the unborn child, and often help to speed labor and fetal descent.

But in medicine, there is always a down side. Epidurals are wonderful, when they work. Even in the most skilled of hands, epidurals are highly technical, difficult to place and maintain, sometimes marginally effective, and frequently fail. They are best placed after the labor is well established, usually at 3 to 5 cm of cervical dilation. If labor is rapid, there may not be adequate time to place an epidural. Minor complications include a 1% chance of a migraine-like headache that may require treatment, and the rare possibility of nerve damage, seizures, infection, or other life threatening problems. Techniques, drugs, equipment, and monitoring used during an epidural anesthetic are all geared toward preventing complications.

Epidurals are usually an elective choice, but not always. There are labor situations in which epidurals may be mandatory for the safety of both mom and baby. Anesthesia for childbirth is unique because the anesthesiologist must treat two patients at once, each one with very special needs. Epidurals are used by default, because other methods of pain control have unacceptable effects on mom or her unborn child. The delicate balance between pain control and safety during labor and delivery is like a tightrope walk. I wonder if Dr. John Snow realized what he started on that foggy April morning in London.

Secret Thoughts Book Trailer:

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H.S. Clark is a mystery writer, physician, anesthesiologist, and the author of Secret Thoughts: a Medical Thriller, set in Seattle. His thrillers are ultimately about the interface of ethics and medicine, and the human struggle for health and wellness. The technology he writes about is 99% cutting edge fact mixed with a 1% glimpse into the future. He showcases the abuses of medicine in order to focus attention on the wonders of medical achievement. Mostly, he wants the reader to enjoy the journey. You can connect with H.S. at his website at:
www.hsclarkmystery.com

Secret Thoughts: a Medical Thriller is available for immediate download from Kindle, and in paperback from Amazon http://goo.gl/UWLVR  

Dr. Richard Mabry: Stress Test

I'm so pleased to host fellow medical thriller author Richard Mabry, MD today to Redwood's Medical Edge. Richard has a new book out and we are running a contest to give away one FREE book to a commenter who is willing to post a review of the novel. In the comments section-- please leave a note about what you'll do to help promote Stress Test along with your e-mail address. Winner chosen at random. Must live in the USA. Winner drawn Saturday, April 20th at midnight and announced here on April 21, 2013.

Welcome back, Richard!

I love the books written by the late Robert B. Parker. You may not recognize his name, but Parker is the man who wrote the novels on which the TV shows featuring private detective Spenser and police chief Jesse Stone are based. I think one reason I like Spenser is that he’s just enough of a smart-aleck for me to identify with him. Someone once asked him why he was a private detective, and I love his answer: “Because I can’t sing and dance.”

What Spenser is saying is that he does what he does because he likes it and can do it well, as opposed to other choices he might have. So, when I’m asked why I write, I have two standard responses. The first, like Spenser, is “Because I can’t sing and dance.” The second is the oft-quoted and very true phrase about true writers: “We write because we can’t NOT write.” And there you have it.

I’m a retired physician. I was in solo private practice for 26 years, then spent another 10 as a professor at the University of Texas Southwestern Medical Center. Although I wrote or edited eight textbooks and had over 100 scientific papers published in professional journals, I never once thought about non-medical writing. Then my wife of 40 years died, and one tool I used to help me climb out of the deep depression I felt was journaling. When a friend read these raw journal entries, he encouraged me to turn them into a book. But I had no idea how to proceed.

From there, it was a matter of attending writer’s conferences, going through the cycle of write/edit/write/edit/write, and shopping the finished product to editors. Fortunately, The Tender Scar: Life After The Death Of A Spouse found a home with Kregel Publications, and it continues to minister to thousands each year. But while I was writing my non-fiction book, authors and editors urged me to try my hand at fiction. I tried it and found that I liked it.

Over the next four years, I quit once and almost quit another dozen times. You’ll notice I said I “almost quit” along the way. Why didn’t I quit? Because, time after time I found myself sneaking back to the computer to write some more. Truly, I couldn’t NOT write.

So that’s why I write “medical suspense with heart.” The genre fits. I enjoy the challenge. And…I can’t sing and dance.

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Dr. Richard Mabry is a retired physician, past Vice-President of the American Christian Fiction Writers, and the author of five published novels of medical suspense. His books have been finalists in competitions including ACFW’s Carol Award and Romantic Times’ Inspirational Book of the Year. His last novel, Lethal Remedy, won a 2012 Selah Award from the Blue Ridge Mountain Christian Writers Conference. His most recent medical thriller, Stress Test (Thomas Nelson), was released in April, and will be followed by Heart Failure in October.