A New Beginning ...

The weekend I got back from vacation (April 6th and 7th) my daughter and her husband were driving up for the weekend to see Ginny, a friend of theirs who was visiting her parents who also live here. My daughter and son in law live nearly seven hours from here, so the drive up is long and hard, especially on the two kids. First place they head once they get in, is to the local drug palace, and of course see people and party with some they know.

My daughter comes home around 11 with little Bella (my granddaughter) and they head off to bed. My son-in-law took their young son, Wyatt, not quite 2, with him to sleep at his mother's house. Both our homes are small and this is typically routine when they come to visit.

The next morning, mother-in-law calls for my daughter telling her that she could not wake up her son (my son-in-law) said he was foaming at the mouth and breathing funny on occasion, was snoring obnoxiously most of the night, and she wanted to know what they had been done the night before? Immediately alarmed as I overhead the conversation, I told my daughter if he was foaming at the mouth and she could not arouse him, then why hadn't 9-1-1 been called as that sounded serious. Instead, my daughter had me drive her over there and drop her off and finally 9-1-1 was called. Good thing, because he nearly died of polysubstance abuse. According to the hospital labs, he had nearly everything in his system, and his kidneys failed. He escaped death, and is lucky, most don't.

Just a week prior, a young woman in her middle 20s died from drug abuse, leaving behind two young children to live with a father they barely knew. Indirectly this story touches a friend of mine, as her daughter (who is pregnant at the moment) is married to this man, who now has his children due to this traumatic event in their lives. How truly sad for the kids. Their mother's family is battling for custody of the children.

Anyway, this weekend turned into two weeks, with him being intubated and in ICU for 7 days and then another 4 days on a regular floor, undergoing dialysis to reverse the kidney damage he had caused his body. It was a mess. All the while my daughter has these two kids and we have no help really from his side of the family, or their extended family. The kids went to daycare and in the evenings were here in the house with me, nearly driving me nuts! Not to mention daughter was very unmanageable herself due to the fact that she is on Suboxone and without the proper dosage of it, she is bitchy and at times to the point of bordering on abuse. It was horrible to see her in such disarray and out of control.

My daughter and her husband both, who now have two children, have been addicts and on heroin and methadone within the last two years, putting us all through hell. They robbed his parents of thousands of dollars to support their habit. It was horrendous, and what the kids went through; it was pitiful. They finally got started at a methadone clinic, which his parents paid for, and once they got stabilized and he got a job, they moved and found a doctor and instead of going to a methadone clinic, got started on Suboxone which at least lets them function normally. For him, he has been able to hold down a job, and soon he will be going back to work.

One can only hope and pray that they realize how precious life truly is, and stop their abuse and mixing of drugs, whether bought on the street or by prescription; if not for themselves, for the sakes of their children, who deserve to have both their parents drug-free, functioning, and willing to love to guide them.

till next time.

What Day Is It?

I guess I've been a little late in posting in this blog site. Since my last post, I have turned another year older, but I'm not sure about the wiser part. I spent the day alone. David called two or three times, singing Happy Birthday to me once; it was funny. He said we would celebrate it when he came the last the month; first of April.

Well, that time has come and gone obviously. He drove down to see me, and then we drove down to Florida. His premise to see me was that he was riding Bike Florida, so instead of doing Bike Florida for real, we kinda mimicked it. We had his two bikes and we rode a few trails. It was beautiful, the trails were well kept and it was nice. I hate to sweat but I did okay; he was impressed! I rode nearly 20 miles the last day we rode on his recumbent bike. This is a weird bicycle to ride. I think if I rode with any regularity I could get into it. I didn't think I could do it, but I even surprised myself and it wasn't so bad. With my B-12 and thyroid issues, my overall fitness is not what it should be at this time, something I am continuing to work on.

As far as David, he rides nearly every weekend. This is his passion, something he does for his health and fitness. He goes with a bike club on Long Island, and often bikes 50 to 60 miles a day, and probably at a fairly break neck pace. Our riding times were strictly leisure and it was enjoyable. Actually this summer he is going to ride cross country with a bike group. This will take two months.

What I missed was time spent just the two of us alone it seemed, we were driving and riding, and where did the romance go? in the evenings we were tired, we ate, and then went to sleep without hardly making love at all. I missed that intimacy it seemed looking back. I think he did too. Next time, he says we will not spend so much time driving, just relaxing in one place.

Yes, that would be nice.

until next time.

Where Have I Been?

I guess I've been a little late in posting in this blog site. Since my last post, I have turned another year older, but I'm not sure about the wiser part. I spent the day alone. David called two or three times, singing Happy Birthday to me once; it was funny. He said we would celebrate it when he came the last the month; first of April.

Well, that time has come and gone obviously. He drove down to see me, and then we drove down to Florida. His premise to see me was that he was riding Bike Florida, so instead of doing Bike Florida for real, we kinda mimicked it. We had his two bikes and we rode a few trails. It was beautiful, the trails were well kept and it was nice. I hate to sweat but I did okay; he was impressed! I rode nearly 20 miles the last day we rode on his recumbent bike. This is a weird bicycle to ride. I think if I rode with any regularity I could get into it. I didn't think I could do it, but I even surprised myself and it wasn't so bad. With my B-12 and thyroid issues, my overall fitness is not what it should be at this time, something I am continuing to work on.

As far as David, he rides nearly every weekend. This is his passion, something he does for his health and fitness. He goes with a bike club on Long Island, and often bikes 50 to 60 miles a day, and probably at a fairly break neck pace. Our riding times were strictly leisure and it was enjoyable. Actually this summer he is going to ride cross country with a bike group. This will take two months.

What I missed was time spent just the two of us alone it seemed, we were driving and riding, and where did the romance go? in the evenings we were tired, we ate, and then went to sleep without hardly making love at all. I missed that intimacy it seemed looking back. I think he did too. Next time, he says we will not spend so much time driving, just relaxing in one place.

Yes, that would be nice.

until next time.

A Mind of Fragilities...

Often times while working, I am typing reports of people who are acutely ill with gastrointestinal issues, chest pain, suspected broken bones, etc., a typical ER scenario, and then there are those lost souls who are depressed, suicidal, or just teetering on the edge of sanity requiring behavioral medicine consultation.

I used to type psychiatric reports of those people who were seeking disability, but no more. It was sad and at the same time interesting to see what state of mind that people were in psychologically. Some were malingeering, others were not.

When you look at this picture, what is it you see? Looks like an abstract right? People are abstract aren't they in all their complexities?



Take the case of this female who comes in with the

CHIEF COMPLAINT: “I’m pregnant and I am bleeding.”

HISTORY OF PRESENT ILLNESS: This is a 25-year-old female who said, “I lost my mucus plug.” She has a very strong history of schizophrenia and bipolar disorder. She says she is G24, P9; (this means she has been pregnant 24 times and has had 9 children) all her children are boys she said and are with their father. She also said that her ex-husband slips in the window at nighttime and has sex with her without her knowing it, and she is here tonight because she lost her mucus plug and has had some bleeding. She said her last period was two months ago. She has had three days of bleeding and today it became a little worse and she came in for evaluation because she thought she had miscarried. Note also that she was very tangential; at times had very limited grasp of reality, and when I showed an intertriginous yeast infection in her abdomen she said that is where her husband has sex with her.

PAST MEDICAL HISTORY: Bipolar and schizophrenia.

SURGICAL HISTORY: Cesarean section.

MEDICATIONS: Includes Geodon and Thorazine.

ALLERGIES: None.

REVIEW OF SYSTEMS: Normal.

PHYSICAL EXAMINATION:
VITAL SIGNS: Blood pressure 126/85, temperature 98.1, pulse 106, respirations 18, pulse oximetry is 98% on room air.
GENERAL APPEARANCE: This is a 125-kilogram, 25-year-old female who is awake, alert, and cooperative.
EYES: Pupils equal, round, and reactive to light and accommodation. Extraocular movements intact. Funduscopic within normal limits. Conjunctivae/sclerae clear bilaterally.
ENT: Pinnae, canals, and tympanic membranes normal. Septum and turbinates normal. Pharynx, tonsils, uvula, and teeth within normal limits.
NECK: Supple with normal range of motion. Thyroid nonpalpable. No enlarged or tender nodes.
RESPIRATORY: Airway patent. Clear to auscultation bilaterally. Breath sounds equal bilaterally. Respirations unlabored.
CARDIOVASCULAR: Regular rate and rhythm without murmur. Pulses normal and equal bilaterally. No rubs.
GASTROINTESTINAL: She has intertrigo and a very obese lower abdomen. Bowel sounds normal. Soft and nontender. No masses or organomegaly.
MUSCULOSKELETAL: Normal strength and normal range of motion. No edema, no calf tenderness, no cords felt. Negative Homans. Negative Pratt.
NEUROLOGIC: Normal sensation. Normal motor activity. Reflexes normal on all four extremities. Cranial nerves I through XII intact. Alert and oriented x3.
PSYCHIATRIC: She is also very tangential; talks very delusionally about things that most likely are not happening, and she does have blood that is old in her panties without any protection being used.
SKIN: Warm and dry. Normal color. No rashes visualized.

EMERGENCY DEPARTMENT COURSE: The patient had a quantitative HCG that was negative with an Rh that was positive. She will be seen by Behavioral Medicine.

IMPRESSION:
1. Schizophrenia with delusions.
2. Intertrigo.

DISPOSITION/PLAN: She will be given some Diflucan for candida, 150 mg by mouth and disposition will be per psychiatry.

I am thinking, does this woman actually have children? and is trying to function in a REAL world so delusional? and if she DOES have children are they too afflicted? Who engages in sexual activity with someone who is obviously delusional? ... and just how does one become so out of touch with reality? It is sad the drugs obviously are NOT keeping her within the realm of this world. One has to wonder.

and about the abstract?

The abstract was formed in a vase that housed flowers a week ago; the flowers were discarded, but everything else remained as seen. Some of the flowers were dyed, hence the red water. As you can see, it left its abstract in a interesting sort of way, kind of reminding me of this sad abstract of such a young female.

just some thoughts thrown out this Sunday.

In Transcription Today...

Today I typed the report of a 30-year-old white female who is about 11 weeks pregnant and developed vaginal bleeding.  States she has had some mild lower abdominal cramping with a past history of ectopic pregnancy.  No recent illness.  She did state that she had an ultrasound in her ob/gyn's office several days ago that shows proximal anencephaly.

I only know of one of one other case of anecephaly that broke my heart when I was in x-ray school training way back when.  What is anecephaly? Anencephaly is a cephalic disorder that results from a neural tube defect that occurs when the cephalic (head) end of the neural tube fails to close, resulting in the absence of a major portion of the brain, skull, and scalp.  Infants with this disorder are born without a forebrain, the largest part of the brain consisting mainly of the cerebral hemispheres (which include the isocortex, which is responsible for higher level cognition, i.e., thinking). The remaining brain tissue is often exposed - not covered by bone or skin.

In the United States, approximately 1,000 to 2,000 babies are born with anencephaly each year. Female babies are more likely to be affected by the disorder. (Don't ask me why cause I don't know, some study I presume). 

Infants born with anencephaly are usually blind, deaf, unconscious, and unable to feel pain. Although some individuals with anencephaly may be born with a rudimentary brainstem, which controls autonomic and regulatory function, the lack of a functioning cerebrum is usually thought of as ruling out the possibility of ever gaining consciousness, even though it has been disputed specifically. Reflex actions such as breathing and responses to sound or touch may occur. I can't imagine how hard it would be to birth a baby who doesn't have a head, or only part of it, only to know that it will die. I still remember the ultrasound technician crying after the patient left the department, seeing this on ultrasound the first time.  The technician herself was pregnant at the time. The particular child in this ultrasound only had a brainstem for a head; no formation of any part of the head or face.    

There is no cure or standard treatment for anencephaly and the prognosis for affected individuals is poor. Most anencephalic babies do not survive birth, accounting for 55% of non-aborted cases. If the infant is not stillborn, then he or she will usually die within a few hours or days after birth from cardiorespiratory arrest.

Prognosis: In almost all cases anencephalic infants are not aggressively resuscitated since there is no chance of the infant ever achieving a conscious existence. Instead, the usual clinical practice is to offer hydration, nutrition and comfort measures and to "let nature take its course". Artificial ventilation, surgery (to fix any co-existing congenital defects), and drug therapy (such as antibiotics) are usually regarded as futile efforts. Clinicians and medical ethicists may view the provision of nutrition and hydration as medically futile. Occasionally some may even go one step further to argue that euthanasia is morally and clinically appropriate in such cases.

Causes:  The cause of anencephaly is unknown. Neural tube defects do not follow direct patterns of heredity, though there is some indirect evidence of inheritance, and recent animal models indicating a possible association with deficiencies of the transcription factor TEAD2. Studies show that a woman who has had one child with a neural tube defect such as anencephaly, has about a 3% risk to have another child with a neural tube defect.

It is known that women taking certain medication for epilepsy and women with insulin dependent diabetes have a higher chance of having a child with a neural tube defect. Genetic counseling is usually offered to women at a higher risk of having a child with a neural tube defect to discuss available testing.

Recent studies have shown that the addition of folic acid to the diet of women of child-bearing age may significantly reduce, although not eliminate, the incidence of neural tube defects. Therefore, it is recommended that all women of child-bearing age consume 0.4 mg of folic acid daily, especially those attempting to conceive or who may possibly conceive, as this can reduce the risk to 0.03%. It is not advisable to wait until pregnancy has begun, since by the time a woman knows she is pregnant, the critical time for the formation of a neural tube defect has usually already passed. A physician may prescribe even higher dosages of folic acid (4 mg/day) for women who have had a previous pregnancy with a neural tube defect.

okay, bloggers, that is your medical lesson for today, however sad it is. Makes me think about those who have a brain and just don't use it (like Lord Spoiled and Griszelda Mess)

(*taken from Wikipedia; *picture source from a medical museum)

Drama Trauma Central...

Dear Blogdom ~

It seems that Lord Spoiled and Griszelda Mess decided to come to Ashland to visit a friend of hers as this friend was in visiting her parents who live here as well. They drove up Friday, and in less than 8 to 10 hours Lord Spoiled ended up in ICU at the local hospital due to an overdose. They hit their favorite hot spot as soon as they hit the city, a known drug hangout and all around party palace. I guess they could not wait to find that "connection" as they don't have one down where they live.

While Griszelda Mess and little Queenie stayed here Friday night, Lord Spoiled and little Prince Wyatt stayed at his parent's home. His mother called here Saturday morning stating that she could not arouse Lord Spoiled from sleep, that he appeared to be foaming at the mouth, so she called Griszelda Mess here to ask what he had been into earlier in the night; however she said she fixed him something to eat before he laid down, and that his snoring woke her up several times. My first reaction was if he was foaming at the mouth why did his mother not call 9-1-1 immediately? Of course Lord Spoiled was not responding to Griszelda Mess either once I got her over there, so an ambulance was called and they whisked him off to the ER.

While in the ER it was determined that he had nearly every drug known to man in his system. What a shocker, huh? Truth is, first it's pot and pills, and heroin addiction, then methadone clinic, Ciboxin (which is supposed to get people off methadone), and of course he needs Xanax because he has "anxiety" at 28 years of age, according to his parents and him. His father has "anxiety issues" as well and his mother has been the breadwinner of the family.

I think his mother, "Mommy Dearest", gets off on her power still over the men in her life in my opinion. Obviously he never got off drugs, he just hid it better, perhaps mixing prescription and non prescription drugs, buying them off the street, whatever, while Griszelda Mess either was doing them herself or turning a blind eye to his abuse of drugs still. He would whine his mommy dearest out of money, after making two thousand dollars a month and not being able to make ends meet? so they in effect they are somewhat to blame for allowing him more funds with which to supply himself.

Your Majesty tried to talk to them, (his parents) about them being duped, but according to them their son does no evil. He is a college graduate for goodness sakes and knows better. yeah right, like that makes a difference. They were totally in shock, thought he was doing well, but that's bullshit too in my opinion. All one has to do is the math. Get real.

Let us not forget also that Lord Spoiled and Griszelda Mess have two children they supposedly love and can barely feed; of course, complaining they don't get food stamps any more?? and first comes their cigarette habits and pills, and then groceries. He keeps my daughter (Griszelda Mess) in the dark as far as finances, and no wonder, huh? I have totally lost respect for this momma's boy- pill popping addict, who is lying over there getting sympathy from everybody when he put himself there. Dumbass.

Of course, "they" (which includes all of HIS family and Griszelda) have surmised that perhaps somebody gave Lord Spoiled a "bad" drug or something; yeah, he was forced at gunpoint to swallow ... I can just see somebody pulling his mouth open forcing it down his throat. Whatever makes their reality seem a little less cruel I suppose. Reality is that both of them have been an embarrassment for two years if not longer, and his parents have closed their eyes to their son's abuse and even pointing fingers at my daughter, Griszelda, for somehow getting him into all of this? yeah right.

I hope to God that ALL of them have finally seen the light here and only good things will happen from here on in. I want Griszelda Mess to be happy and healthy and have a good life, but have my doubts on that one. She seems to think that she needs Klonopin to sleep at night. Here are two supposed adults who have children who feel the need to rely on pills to get through their day and function. I tell you I don't know how their heads got so screwed up. Griszelda Mess was NOT raised that way; she was NOT abused or neglected or any of that, and neither was he. If anything they have had ample opportunity to get ahead in life and have chosen a few wrong turns. When will they finally stop and become responsible adults?

In the meantime I have been bombarded after having a decent vacation with Daddy Warbucks to come home to this drama?

They have him sedated on respiratory assisted machines, IV lines going, he is getting the best of care, and of course his parents are over there instead of helping with their grandchildren; I am the dump person here. I haven't been out of house for two days, subjected to a whining almost 2 year old and a 5 year old. Fun times for me, not that I am not glad to see the babies, but it is NOT my job to take care of them 24/7. Your Majesty still works for a living, so Griszelda Mess will have to come up with a plan. Perhaps his mommy dearest, instead of supplying help with the children, can pay for daycare or splurge a motel room to house them. After all, wouldn't this better than giving Lord Spoiled more drug money?

I am glad he is going to make it, otherwise Griszelda Mess would have another good excuse to start doing drugs (or keep doing them) because she was stressed out and depressed and had nobody and would pity herself to death's door next. I doubt either one of them will have learned a darn thing, but time will tell. I figure he is going to be upset that the truth has finally come out about his behaviors and he got "caught." Maybe he'll go to church, repent and turn his life around; one can only hope, and at this point, salvation looks to be the only thing to save these two children who are innocently caught in the middle of their parents drug-induced dramas.

To be perfectly honest, I am almost embarrassed to say that I just can't wait to see them leave town, and that day can't come too soon!