Mini-moles

This is the fifth, post-symposia revelation; and I wonder, does anyone else doodle in words like I do?
likely not. It is amusement and part memory method. So here is the latest nonsense.

Mini-moles
Very small rodents
Seemingly important, they say,
Something regarding
Umbilical LDL
Not seeing the light of day,

Supposedly at birth
Your U-LDL
Resides at a measure below 50,
But that's kind of silly
You never have eaten
Ya, extraneous data is shifty.

The Cholesteral-HDL ratio
Is a predictor of some kind of risk,
Particular with folks of Diabetes
Don't ask me, but something is brisk,
That's just about where the after-lunch dude
Was guiding us all into sleep,
I suspect he has earned a favorable rating
As we awakened; man, that nap was so deep!

For Giving, that's who we are

End of days ponderings:

I feel kind of alone
Going to classes and such,
It's just one of those things
That I enjoyed very much,
Sharing moments of learning
Perhaps I'm just such a geek,
Feeling a need for expansion
If only just a peek.

Rubbing shoulders with colleagues
Over the years,
We all got a little older
And shed a few tears,
As we all are wont to do
On this human path of living,
And hopefully we have acquired
More capacity for giving.

The Best New Drugs

Every year at one conference or another, a presenter will regale us regarding the use of Wonder drug Z, and all the other great stuff in the cue. Some of those drugs disappear, never to be listed, because the side effects began to show up after 300,000 people had been tested against placebo. Maybe their toes began to fall off, or there were too many folks dying from long thumb disease, or whatnot.

The Best New Drugs

Death eliminates all risk
LDL reduction is very brisk,
Approaching zero, as the heart stops beating
After that, no worries about eating.

Sodium reduction has a lot of hype
Not sodium sensitive? you're not the type,
Regarding all that worry, about retaining fluids
No need to join the low sodium Druids.

Sodium-glucose Cotransporter-2 Inhibitors
If you can say that, you're clearly an exhibitor,
But they never talk about
Those incidental amputations,
Or how Fournier's gangrene
Can ruin a reputation.

Beware, dear public
About the newest, latest drugs,
Testing on rabbits, rats and pigs
May not eliminate all the bugs,
Lurking in the background
Glossed over by slick advertising,
If you should get Angioedema
Death may be very surprising.

10/30/18

Price versus Advice

More nuggets of information, from the symposium. If Joe Bob can drop a kilogram of weight (2.2 lb)
this may lower his Systolic BP, by an average of 5 mm of mercury. This alone, can be an organ saver.
But, there is the topic of compliance, isn't there?

If you drop your weight
By one kilogram,
2.2 pounds
It will be favorable, M'am,
To bring your systolic
Down five millimeters,
That might save you a kidney
Unless you're one of those cheaters,
That puts the weight back on
After you leave the Clinic,
You loved all that praise
But you're just a cynic,
Not believing a bit
About all that good advice,
You don't worry about pounds
You only ask about the price.

10/30/18

Syncope Slide

I went to our local Cardiology Electrophysiology Symposium two weeks ago, and learned some good stuff. Man, those physicians love to strut their stuff regarding favorite topics, but there are usually some good nuggets of information.

For example, about 50% of folks who take blood pressure meds for hypertension, still have lousy control, and as such, remain at high risk for deadly complications. We were informed, that better success is achieved if two different medications are working together, rather than just doubling the dose of a singular drug. However, the discussion did not address the added risk of additional side-effects that might come along with those secondary medications.

Anyway, life itself is risky...........and doctors are averse to blame.

Slide

Lowered your BP

But still you died,

When you busted your hip

Doing the Electric Slide,

Thanks to your doctor

Adding another medication;

The plaque on his door reads:

"Your health, is my dedication".

He’s a BP control freak

He studies all the trials,

And as a result

You should see all the vials,

Stacked on the counter

At Billy Bob’s house,

16 plastic bottles

Between him and his spouse.

Meanwhile, the doctor

Basks in recognition,

Writing books on medicine

The latest rendition,

On BP control

All the methods he has tried,

But nowhere will you find

Just how many have died.

He had no hand in that

Never takes any blame,

P-value significance

Is the name of the game,

Statistical variants

Like a bolt of lightning,

Impossible to predict

And that’s what’s so frightening.

Syncope

Is what happened to you,

Your blood pressure crashed

As its likely to do,

After that fourth medication

Was added to your list,

Now that you busted your head

You will be sorely missed.

We’ll get your pressure down

The doctor had reassured,

You’ll feel a whole lot better

The hypertension cured,

You can fulfill your dream

To learn the Electric Slide,

Yes, I fixed you, old man

But still you died.

Gunning for Retirement

Gunning for Retirement

Another great plan
For when I retire,
An alarming inspiration
Truly did inspire,
For me to think of a way
Where nurses can blow up their stress,
Come to Billy Bob's shooting gallery
It won't matter how you dress,
Because you get to choose
Your favorite cannon,
Please, let me explain
Just what I am plannin'.

I have endured enough
Of every kind of alarm,
My psyche is maimed
With significant harm,
My ears ring incessantly
I dream beeps and sirens,
That's not what I call peace
In any environs,
So, my plan is a shooting range
To vent your frustrations,
Blast those infernal machines
To hell and damnations.

I figure a five minute session
Ten shots in all,
Pick any weapon you like
It's absolutely your call,
The lockers are stuffed
With every kind of gun,
From small stinger missiles
Or some desert eagle fun,
It's all a part of stress relief
Cutting loose with a scream,
Blow up that IV Pump
Like you did in that dream.

The worse flippin' alarm
That I ever heard,
Is on that CRRT machine
Like a foghorn, my word,
So that is my target
With a shotgun to blast,
10 gauge for sure
Nice and slow, meant to last,
Ten shots in all
To damage and maim,
Twenty bucks admission
Come on, play this game!

Can't Remember

I was talking with one of those young nurses of the day, bright as an atomic bomb, and probably the type I'd want on hand if I was in the ICU. She noticed I kept a small note/list on my phone that covered some of the common IV drip mixes and calculations, and it prompted a discussion of this thing.

Hence, I wrote this:

It's the middle of the night
And you can't remember,
The drip calculation
You learned last September,
And it's really important
Because you're at the Code Blue,
It seems like everyone is staring
And waiting for you.

You reach for your phone
It's in one of your pockets,
In your deluxe cargo pants
That hold 42 sockets,
When you suddenly realize
The smartphone is gone,
When you were rushing to work
It fell on the lawn.

Joe Bob the victim gasps
"You can use mine",
Look up Cardiac Arrest
Dial 249,
Ask for Betty Lou Johnson
Also known as my wife,
First ask her opinion
If you should save my life.

The moral of the story?
Keep your tools close at hand,
Know those drug concentrations
For those moments on demand,
When you're on the spot
And Joe is circling the drain,
In those crazy, clutch moments
You gotta trust your old brain.

Prolonging life without consent

Dementia & Pacemaker

DNR
Do not resuscitate,
A reasonable approach
To a dead end fate,
And one might argue
We all will die someday,
But if you have severe dementia
How long would you choose to stay?

Why do I ask? I'll tell you
I just met Betty Jane,
About the only thing she understands
Is to localize her pain,
No kind of simple words
Can appeal to any reason,
Betty's brain is at survival mode
And it's a long and pointless season.

She lives her life in a nursing home
Her cognition is unaware,
She can not form a memory
Nor have a thought to share,
She truly lives in the moment
Each minute is unique,
Though she can't recall the one before
Nor anything last week.

She doesn't know her children
Where she lives, or anything,
No purpose of existence
But she can walk and sometimes swing,
So a DNR is sensible
Yes, she requires a caretaker,
But honestly I think
It's a crime to give her a pacemaker.

She didn't request or pay for it
Just who made this choice?
And why would they do it
When Betty has no active voice,
Regarding her life
Without cognitive awareness,
I'm guessing it was family
Well meaning, without fairness.

Yep, a pacemaker just a month ago
Her heart was slowing down,
She had a bout of syncope
Where she lived in memory town,
A doctor intervened
Made a referral out beyond,
The care-center demanded it
"She might pass out at the pond!"

Naturally her son
Didn't want to miss his momma,
Despite the fact she doesn't know
A period from a comma,
So they shipped her out
Said, don't come back
Until your heart is stronger,
We'll await with open arms
To help you live a little longer.

Betty doesn't understand
Why her chest is sore and tender,
She scratches, picks and plucks
Till the incision doth surrender,
Where infection did ensue
Promoting gross and smelly pus,
Whereby the folks at memory town
Stated; you can't stay with us.

Another long trip to the hospital
A hundred-fifty miles away,
While everyone at memory town
Said, Betty we will pray,
For another speedy recovery
For a long and fruitful life,
When you come back, see Bobby
He is looking for a wife.

Halloweenish

Well, I'm in a bloody good mood lately, feeling like I should bite someones neck, and it is the Halloween season after all. Thus, I'm inspired by vampires and blood donations.

Blood Supply

I have read a lot
Of vampire books,
Depends on the author
Just how vampires look,
But there's a general consensus
Regarding aging, and such?
You'll be frozen at the age
Of your vampiric touch.

The rumor is
That they bite your neck,
A lot more vigorous
Than the little peck,
That you got from Eunice
Back in the fourth grade,
Ya, her mother was a vampire
And that's why you're afraid.

Historically vampires
Get a bad rap,
You may have heard about silver
Crosses and crap,
Designed to repel
Your friendly neck biter,
Every vampire I've met
Was a heck of an inviter.

Well, I suppose that is necessary
To maintain the blood supply,
It has a short shelf life
Because even blood will die,
And they don't bite the dead
So, your chances are good,
How best to avoid a bite?
Wear a chain-mail hood.

Blood Donation

I donated blood yesterday and here is what happened.
(In the event that you may be following this blog, my encounter with the blood chick, turned into something like when I visit with Dental Dana).
Who would ever think that donating blood could be so.....................delicious!

Rachel
That woman, she took my blood,
When I swooned
I fell with a thud,
Awoke light-headed
Like a spinning jenny,
Not only my blood
But the blood of many.

Rachel
Caught my eye at first,
Before I understood her thirst,
No, I won't argue
She was really cute,
I needed to see her....
I was resolute.

Rachel
Looks so young, that kid,
When I came to donate
She had the highest bid,
And now I'm drained
I guess; good to the last drop,
Rachel, I begged
Oh please, don't stop.

Rachel
So caring, she held my hand,
After I swooned
I could no longer stand,
I was laid on the gurney
And they lowered my head,
I was too weak to grasp
To pull her onto my bed.

Rachel
She stood to the side,
I caught a little smirk
Plus a wink, and I sighed,
Knowing, she tried to drain me
I guess I have a good taste,
She whispered in my ear:
"To the last drop; I mustn't waste".

Don't try to sue me

Gotta do something when I retire.

Don't Try to Sue Me

Here's a plan
When I retire,
Publish those books
And set the world on fire,
With all my funnies
And juvenile humor,
Silly as vomit
And bold as a tumor.

Amazing insights
Regarding amputations,
Ridiculous rhymes
And ambiguations,
Touching stories
Regarding life and death,
Spirits in the closet
And the Grim Reaper's breath.

There is a lot to cover
And I think I did,
I worked like a man
And thought like a kid,
Did my best to respect
Joe Bob and his cousins,
See, they looked kind of inbred
With children by the dozens.

There was Billy Bob Borko
And sweet Betty Lou,
Sister Euphemia
To name just a few,
Of the colorful characters
Whose paths I have crossed,
Most of them winners
Although a few of them lost.

I followed most guidelines
But stretched a few rules,
Some protocols, dear reader
Have been written by fools,
Who rarely endeavored
Into the milieu of reality,
Where the evidence of poor science
Might lead to fatality.

Am I an expert?
I don't claim to be,
But I do write with clarity
Regarding things that I see,
Armed with continuous
Ongoing education,
Regarding areas of interest
To support my reputation.

If I can be an inspiration
Let it be known, that I cared,
Regarding expertise
And the knowledge that I shared,
And always willing to work hard
In any kind of conditions,
Admirable traits
Outside of personal ambitions.

Well, I will keep writing
About the usual baloney,
The whackified truth
Not fake and not phony,
And yes, I hide names
So don't try to sue me,
Take your business elsewhere
And stop acting gloomy.

Nurse Centered Care

Patient-Centric Care. By golly, that sure does sound good, and I bet there are hundreds of papers and studies all wrapped around that feel-good concept. But let's talk reality! In the ICU and Recovery Room, we are talking Nurse-Centric Care. As in: The Nurse runs the show, knows what is best, and don't screw with us, if you want to see Joe Bob walking down the healing road to recovery.

Maybe that's how we old gunslingers see the world. We anachronisms of the old west, firing our pistols off, just to hear the big bang, and to smell the gunpowder. Who cares; I'm unplugging soon.
Just don't get it into your heads, that I'll stop writing about this, ok?

Not To Speak

After general anesthesia
Short term memory rules,
As you begin to wake up
You'll be missing some tools,
And may ask the same question
Over and over again,
We'll repeat the same answer
Like a stuttering hen.

In respect to the family
There are three things, not to speak,
Don't ask Jerry if he has pain
Or if he has to take a leak,
And most of all, never
Ask if he is nauseated,
His short term memory will cling
To the idea you perpetrated.

The Anesthesiologist
Gives meds for dizzy indigestion,
No one wants it to happen
Please don't give Jerry an auto-suggestion,
Because his brain will latch on
To that five letter word,
His circus memory will focus on VOMIT
He may start retching, undeterred.

Sure, I care about his history
Of his sensitive tummy,
You probably run to his side
Like the very best Mummy,
Each time he has a burp
And spits up a little rice,
But do be aware;
Encouraging vomit, is like rolling the dice.