February 25, 2008

Dr. Dolittle Meets Dr. Marvin Monroe

Zoo and wildlife medicine specialist Romain Pizzi finds that pets are increasingly being prescribed anti-depressants because they cannot discuss problems in their lives with others.    (Read the article...)

Mr Pizzi said the severity of some pet’s depression may put its life at risk. Parrots are especially vulnerable. They are known to engage in self-mutilating behavior, like plucking out feathers, when their depression is left untreated.

I can see that. The bird's confined to a cage and surely suffers by hearing the refrain 'Brawwwwk! Polly want a cracker?' a thousand times each day. I'm sure the bird wants to roll his eyes each time his owner performs the imitation, which inevitably ends with the caretaker chuckling at his own ingenuity.

"Last year, Eli Lilly released a chewable anti-depressant for dogs onto the US market. The manufacturers even gave the “Reconcile” drug a beef flavour."
As investigators probe deeper into animal health issues (especially animal mental health), it can't be long before veterinary neuropsychiatrists will provide the answer to that age-old riddle: Why did the chicken cross the road?

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February 18, 2008

WTF - World Takes Flak - For Obesity

Professor Philip James, chairman of the International Obesity Task Force, a London-based think tank, called for a revolution in urban planning to encourage people to use cars less and public transport more.

At the annual meeting of the American Association for the Advancement of Science , Professor James presented at the Town Hall Understanding Obesity workshop. He said that it is "naive to expect people to lose weight by making better choices about diet and exercise when their surroundings encourage inactivity.

Professor James blamed the world in which we live for the behavior-based obesity epidemic. (read more...). To recap his presentation: Urban developers created an obesogenic environment by planning public spaces around the car. Business improvements that have increased desk work and reduced physical labor, and product engineering improvements in everyday items, including electric toothbrushes and can openers reinforce a more sedentary lifestyle.

'Blaming individuals for their personal vulnerability to weight gain is no longer acceptable in a world where the majority is already overweight and obesity is rising everywhere,' said Professor James...The environment in which we live is the overwhelming factor amplifying the epidemic.

If you're not at your ideal weight, don't worry...it's not your fault! The remote control is to blame!
What a relief! For a moment, I was worried that individuals would be assessed some degree of accountability.


The AAAS symposium wraps up today.

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February 16, 2008

High School Crush: Corridor Chaos

Twenty-five students were injured in a pile-up in a school corridor triggered when a freshman stopped to fix her shoe.
Paramedics were called to the school to treat pupils for crush injuries, including ankle sprains, bruising and sore heads.
All the students were sent home following the incident, several were taken to hospital and five were kept off school the following day.   
Read more...

A spokesman for the Royal Society for the Prevention of Accidents commented, "the consequences of such an event as this arising can be disproportionate to what started it." I suppose it won't be long before we see zero-tolerance to shoe fixing added to the school's behavior code.

I think we can all see this lackademic institution's position on the learning curb.

When life gives you lemmings...
Lemming Aid (Winner: Best Short Film, Cannes, 1994).

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February 14, 2008

Drug Recall Information Needs A Fix

Quite by accident, I discovered a drug recall that affects me. The recall on Fentanyl was announced earlier this week. On Monday, I received a 5-week supply of the medication that is part of the recall. My existing supply is included in the recalled lot too.

The recall was widely reported throughout the U.S. news services, but there was no information for patients in Canada. The notice from J & J / Novartis clearly stated that supply in Canada and The United States was affected.

Ranbaxy Pharmaceuticals Canada, distributors of Duragesic in Canada, doesn't provide information of the recall on their website.
Health Canada maintains a comprehensive list of warnings and recalls...but nothing about defective Fentanyl patches.

Today, eCanadaNow is at least offering an item announcing the recall.

From the recall notice:
The Duragesic Pain Patch has been recalled by Johnson & Johnson because defects in the manufacture of the patch could lead to accidental overdoses. Johnson & Johnson is recalling about 32 million of the fentanyl-containing Duragesic Pain Patches, and the company estimates that about two million could be defective.
Fentanyl is considered a Class II substance by the Drug Enforcement Administration, meaning it is associated with a high potential for abuse and a risk for fatal overdose. Fentanyl is an opioid analgesic, approximately eight times stronger than morphine.
The recalled patches, manufactured by Alza Corp. and sold by PriCara and Sandoz Inc. in the U.S. and Canada, are strength of 25mcg/hr and have expiration dates on or before December 2009. Patches with 12.5, 50, 75 and 100 mcg/hr strengths aren't affected.
Patients can call 1-800-567-3331 for more information.


I'm not sure why they'd want patients to call. Because it's a regulated drug, a pharmacist has to arrange replacement supply.

Janssen's Medical Information Department advised my pharmacist that information about the recall will be provided to medical professionals, including pharmacists, over the next 7 days.

I already educated myself on proper precautions in case I have any defective product. I know that Owen will take care of this for me, but with just one dose in the cupboard and a long-weekend coming up, I'm mildly concerned.


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Mac's Opinion Linkfest

February 13, 2008

Science Explains a City's Sport Discord

Through our children's sports teams we have oft had the displeasure of playing against a particular city's teams. Whether it was in boys' hockey, girls' hockey, volleyball, soccer or football; in exhibition, regular season, tournament or playoff action; from Peewee through Bantam to Midget; I have consistently witnessed cheap hits, a higher incidence of fighting and overall poor sportsmanship by players and even some bench staff of teams from this particular city.

After an especially dangerous season, some boys' hockey coaches refused any more exhibition games against teams from this city. Last month, Jessica's hockey team played against a team from this city. There were ejections, suspensions and a ton of penalty minutes. On the drive home, we discussed several possible theories for the agitated intensity displayed despite the high talent of the players.

Thanks to results of a study released by European researchers, we finally have our answer:
Air Traffic Noise Increases Blood Pressure.

It's not the water. It's not a volunteer recruitment program that only accepts coaches willing to standardize dirty play. It's the planes!

It's not just a source of irritation, it's bad for residents' health, said epidemiologist Lars Jarup, leader of the study at Imperial College London.

Brampton is just 4 km from Pearson International Airport, Canada's busiest airport.

The Greater Toronto Airport Authority's noise contour map clearly includes Brampton within its noise operating area (click map to view map of noise estimate).

Explaining it doesn't justify it.

In the name of fair play, send 440,000 pairs of earplugs to City Hall for immediate distribution...before Jess's team draws them in the first round of the playoffs!

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February 12, 2008

Post Viral Snow Fatigue

I didn't see a doctor this Monday. That's almost a reason to celebrate. I'm still toxic with infections, but have these these new symptoms: muscle aches, cold in the extremities and an ache between my shoulder blades that radiates into my neck from scrunching my shoulders to my ears in the wind.

I have Post Viral Snow Fatigue. I definitely have it - the infections coupled with a dread of fluffy white stuff that's been falling from the sky.

Except the stuff that's been falling hasn't been fluffy; it's been heavy snow. One shovelful weighs 7 lbs.

The report is that more than 60 cm of snow fell. Forecasts call for another 20 cm overnight tonight.

One snow day during the exam-week; two more snow days last week and some are betting on sleeping in tomorrow, too.

Last week, Matt and I pushed 3 cars out of the snow in less than 1 hour...one guy twice! "It's surely a sign to stay home," Matt told him. Between rescues, Matt and I were each carting snow across the road to the ravine, because there's just no other place on our side of the street to put it. Jessica, home on the snow day, was clearing the other neighbor's driveway - rent for the shovel I borrowed - but was oddly absent when the cars were stuck.

We live on a bus route, so our street is among the first to be plowed. It's plowed twice as often as the side streets. It's good that we can drive on our street...that is, after we clear the drifts left behind by the plow...which are left twice as often as anyone who lives on the sidestreet. The mess left by the plow is even heavier than the regular stuff, thanks to having been packed down by the traffic, including the buses.

On the roads, I'm tired of driving behind the person who is obviously not comfortable driving in the conditions. On the highway, drivers of those oversized SUV's racing past on the shoulder are sometimes too confident in their driving ability.

Thirty-eight days until spring. I'm taking two more aspirin...I'll call you in the morning.

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February 06, 2008

More Tales From the E.R.

People-watching inside the treatment zone just isn't the same. In the waiting room, you control your privacy; back here you don't. It's not just about the gowns and curtains. It's also about repeating your story - why are you here? what's your health history? - not to mention the staff discussing the cases.

When speaking with somebody whose first language is not English, why the hell do people repeat themselves, only louder? Yelling is not a translation tool.

With his shift coming to an end, the doc had to re-evaluate and chart almost 70 patients before he could leave. Each consult request, diagnostic order and discharge created a mountain of charting. He wasn't showing any stress.

The bell announcing new patients arriving hadn't stopped all night. The problem was flow-through. Admissions wait for a bed upstairs. Docs wait for results and consults. Nurses wait for orders to be written. Patients wait to be assessed.

Patients are bounced from room to hall, to room to hall, depending on what's available when you get back from a diagnostic. Once I lost my room, I was bounced from the side of the nursing hub to in front of the supervisor station. I now know more about the technical difficulties of the new integrated computer system than I need to. I know the fax number. I know that if I ever need to call to check on someone in the E.R., 7:30 a.m. is not the best time to call.
I have formed an opinion on the inter-departmental power struggle that impedes efficiency of the overall operation.

Since people stories are always fun, here's a couple:

Meet J., the man who injured himself after too much fun. He may or may not be seriously hurt. From the time I first lost my room, any time I got back to the department, J. was always in next stretcher. It was his level of impairment that made it hard for him to know the date, not necessarily his injury. He was not a happy drunk though. Security had to be called a couple times to restore some order.

Twelve hours after I'd arrived at the E.R., a woman was led into the treatment area. She had been in the waiting room when I'd arrived and I'd pegged her as family support, not a patient.

My mala-dar was way off.
Or was it?

She was very loud in describing her situation. People were pulling coats and blankets over their heads to mute the sound. Eventually, a specialist was called. I know this doc. He's a soft-spoken professional. His attempts to have a quiet discussion with her were unsuccessful. Then the doc's voice boomed: "Let me get this straight. Approximately 30 hours ago you may or may not have had an allergic reaction, to an unknown substance. Regardless, you are no longer showing any signs of reaction. In fact, you had no symptoms of an allergy when you arrived yesterday. There is nothing I can do for you. Try to identify something that you ate or touched or was near yesterday that was out of the ordinary for you. Then expose yourself to it again. If you experience similar symptoms after exposure, then it may be an allergy. The only successful way to treat an allergy is to avoid exposure to the trigger. There are plenty of good over the counter treatments to make you more comfortable in the event of a reaction. In the event of a serious reaction, you would need to go to the E.R. A serious reaction includes shortness of breath, generalized swelling and numbness and fainting. I will discharge you for now."

Up til then, I'd never heard a curtain slam.

February 05, 2008

Tales From The E.R.

You can't be surprised that I have a distinct dislike of Emergency Rooms. I especially hate Emergency Rooms on Mondays. Unable to negotiate a better resolution to an ongoing issue, I found myself at the E.R. on Monday.

Armed with notes, reports, and lab results from the doc who just sent me over, any hope of making this a quicker trip was dashed when I saw there were no empty seats in the waiting room. I was triaged and registered quickly. The wait was underway.

The dynamics are odd here - like an intimacy that permits some to share their health and family histories with strangers. People-watching is sport in almost any E.R. waiting room.

There were patients, parents, family members and friends. While they continued to doze in their chairs, feign interest in the all-news station on the T.V., or flip pages of books and magazines, I conducted my own triage assessment of the waiting room. Eventually, I got a seat under the television. I could read the magazine I'd brought with me and listen to the continuously updated news at the same time. It was a great place to watch the room.

There's a woman, holding an older infant. The boy on her lap is under 2, dressed only in a diaper and t-shirt. He is red from (my guess) fever, his posture is limp, his eyes are mostly closed, occasionally he gives a whimper. His older brother appears to be 4 or 5. He's doing a great job of passing the time while they wait.

Across the way, is an inter-generational grouping: Grandpa's in his 60's; Mom's in her 40's; her son is 4 or 5. At some point earlier in the day, the boy had been unwell. He was obviously feeling better now: he ate the snacks, drank the soda, finished the juice and the water. He climbed over the furniture, under the furniture, over the stroller, under the stroller, rammed the stroller into people who were a little less-appreciative of his exuberance. "He's feeling so much better, why don't we take him home?" Grandpa suggested. Mom didn't want to take a chance that he'd take a turn for the worse and lose his place in the triage line.

After about an hour, Brother Across the Room observed "That boy doesn't seem sick like Younger Brother. Maybe he doesn't need to see the doctor anymore." I laughed inwardly, but could not miss the nods from some of the people in the room.

There's a couple in the corner that I recognized from the neighborhood. Their dog is a small, fluffy, friendly-enough mixed breed. I couldn't tell if one them was unwell or if they were waiting for somebody who was in the examination and treatment area.

We learned all about D's family. She's a vibrant woman in her 90's (92 in August!), the second daughter of 4; her younger sisters are twins. I didn't change seats to view pictures of her family, but a couple people did.

At 11:00, the crowd thinned. Several people decided they'd waited long enough and headed home. I wasn't too surprised by their decisions. They were all people I'd personally placed at the lower end of the priority scale. I thought one couple was leaving their daughter behind - I had put the three together - I'd played that one wrong.

As people arrived and left, I adjusted my triage-game. I had set my own 'go-home-time'. I'd be more comfortable feeling unwell at home, if I couldn't get meaningful treatment tonight. I would ask for the notes and papers back and just try again another time. I didn't need it. I was in the treatment system before that time rolled around. It's a big step forward through those sliding doors, but ultimately, it's just a different kind of waiting.

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