20 dose

Please don’t touch bats unless you know what you’re doing!

Bats can carry the rabies virus and by coming into contact with one or being bitten, you may be in danger of contracting the disease. Rabies is lethal!

Rabies post-exposure prophylaxis includes a four shot series of the rabies vaccine and one administration of the rabies immune globulin (human). The rabies vaccine is administered as an intramuscular injection on days 0, 3, 7, and 14. The rabies immune globulin is administered on day 0 as multiple IM injections based on a 20 units/kg dose. If there is a wound, the immune globulin should be injected into and around the wound. If not, it should be administered as IM doses far from the site where the vaccine was given. Keep in mind that single IM doses should usually be 2.5 mL or less.

Example: A 75 kg man comes in to the ED after having contact with a bat. There is no wound. The patient should receive one dose of the vaccine in the deltoid muscle of one arm. For this example, we’ll pick the right deltoid. The patient then needs a dose of rabies immune globulin. A dose of 20 units/kg comes out to 1500 units. The strength of rabies immune globulin at the hospital is 150 units/mL, so the total dose will be 10 mL. Keeping in mind the volume limit of IM injections, this would be divided into 4 syringes containing 2.5 mL of the rabies immune globulin. These 4 injections would be delivered to separate sites from the rabies vaccine, such as the opposite (left) deltoid, both lateral thighs, and a gluteal muscle. After leaving the emergency department, the patient would need to receive 3 more vaccinations on days 3, 7, and 14.

Bicycle Day April 19, 1943 

Animated by Psychedelic Preacher.  My Art | Shared Art

April 19, 1943, Hofmann performed a self-experiment to determine the true effects of LSD, intentionally ingesting 0.25 milligrams (250 micrograms) of the substance, an amount he predicted to be a threshold dose (an actual threshold dose is 20 micrograms).Less than an hour later, Hofmann experienced sudden and intense changes in perception. He asked his laboratory assistant to escort him home and, as use of motor vehicles was prohibited because of wartime restrictions, they had to make the journey on a bicycle. On the way, Hoffman’s condition rapidly deteriorated as he struggled with feelings of anxiety, alternating in his beliefs that the next-door neighbor was a malevolent witch, that he was going insane, and that the LSD had poisoned him. When the house doctor arrived, however, he could detect no physical abnormalities, save for a pair of incredibly dilated pupils. Hofmann was reassured, and soon his terror began to give way to a sense of good fortune and enjoyment, as he later wrote…

… Little by little I could begin to enjoy the unprecedented colors and plays of shapes that persisted behind my closed eyes. Kaleidoscopic, fantastic images surged in on me, alternating, variegated, opening and then closing themselves in circles and spirals, exploding in colored fountains, rearranging and hybridizing themselves in constant flux …

The events of the first LSD trip, now known as “Bicycle Day”, after the bicycle ride home, proved to Hofmann that he had indeed made a significant discovery: a psychoactive substance with extraordinary potency, capable of causing significant shifts of consciousness in incredibly low doses. Hofmann foresaw the drug as a powerful psychiatric tool; because of its intense and introspective nature, he couldn’t imagine anyone using it recreationally. Bicycle Day is increasingly observed in psychedelic communities as a day to celebrate the discovery of LSD.

vimeo

The psychedelic drug (or entheogen) lysergic acid diethylamide (LSD) was first synthesized on November 16, 1938 by the Swiss chemist Albert Hofmann in the Sandoz (now Novartis) laboratories in Basel, Switzerland. It was not until five years later on April 16, 1943, that the psychedelic properties were found.

On April 19, 1943, Hofmann performed a self-experiment to determine the true effects of LSD, intentionally ingesting 0.25 milligrams (250 micrograms) of the substance, an amount he predicted to be a threshold dose (an actual threshold dose is 20 micrograms)… The events of the first LSD trip, now known as “Bicycle Day”, after the bicycle ride home, proved to Hofmann that he had indeed made a significant discovery: a psychoactive substance with extraordinary potency, capable of causing significant shifts of consciousness in incredibly low doses. 

https://en.wikipedia.org/wiki/History_of_lysergic_acid_diethylamide?wprov=sfla1

Anniversary

I’ve been working in this job for almost a year now. Here’re some things I learned in that time:
1. Always be as proactive as possible. The more issues you address on your own terms, the less you have to address on others’. 
2. Pay close attention to I/Os and daily weights. Some patients get fluid up or down subtly, and won’t show symptoms until their blood pressures start dropping or they get pulmonary edema. 
3. If part of a treatment plan seems off, do some information gathering. Sometimes you’re the only one who’ll catch something before it slips between the cracks. 
4. Humans are amazingly hardy and ridiculously delicate. 
5. Talk to people. Take some time after rounds to visit with your patient as another person instead of a provider. 
6. When patients get ornery, that usually means things are improving. 
7. Sometimes you just know that someone’s going to die before they leave the hospital. 
8. When covering another provider’s patients, read admission and prior history and physicals. Get a good context for why they’re here. 
9. You’ll vagal the first time you do a bone marrow harvest. It doesn’t matter what your background is. 
10. Get consults early if you think you’ll need it. Scrambling is bad for everyone involved. 
11. Don’t feel self-conscious about dictating. If we tease you because you hit the wrong buttons, started again, laughed too hard to continue, hung up, and then restarted - it’s because we’ve all been there. We’re not judging. 
12. Occasionally, the brand-new immune system will decide to kill the patient instead of the residual cancer. 
13. Always have a backup plan in case something goes sideways. 
14. If you have a neutropenic patient who’s febrile and hypotensive, don’t be shy - fluid bolus and throw penem/vanco/tobra at them until the cavalry arrives. 
15. General internal medicine and stem cell transplant oncology have some overlapping elements, but there’s a huge difference in management, medications, etc. It’s like trying to understand French as a Spanish speaker. 
16. Be polite to everyone. Techs, nursing staff, housekeeping, fellows, residents, attendings, whatever. 
17. Eat, caffeinate, and bathroom when you can. Murphy’s law says if you skip a chance, that’s when poop hits the fan. 
18. Keep reading and learning. Knowing more leads to better medicine and better patient experiences and outcomes. 
19. Know at least basic radiographic and ECG interpretation. Yes, the specialists will give you the expert opinion, but if you want to know something right now it’s much faster to look at the images/ECG yourself. 
20. Someone on high-dose corticosteroids may not develop a fever in response to infection. 
21. Don’t change things just for the sake of changing things. Sometimes it’s better to just wait a day or two to see what direction your patient may go.
22. Providers work as a team. Help each other out. Not busy but the other folks in the room are running hard? Check on patients or return calls or do orders for them.
23. Be kind and warm to those entrusted to your care. To them you may be the only glimmer of light in an otherwise very dark time.

TURMERIC PILL REPLACEMENT

Listen up you alternative medicine loving people, here’s a thing I did for my mom today. 

So, mom’s got some joint trouble. “Go to the doctor,” I said. “They won’t do anything for me. But my friend gave me some turmeric pills that worked great,” she said. “Okay,” I said, thinking she may as well be taking a sugar pill but whatever if she feels better ok. “They’re $25 for 20 doses, though.” she adds, sadly, because that means she’s not getting shit because who know who doesn’t have cash? My mom. 

“Oh. Hell. No.” I said. 

And then I marched my ass down to the local co-op and they’re selling these turmeric capsules for $25 for 20 and that’s the bullshittiest. THE BULLSHITIEST, FIGHT ME. 

So then I marched my ass back to my house and got out my spice jar and a half pint mason jar. 

Mix the shit out of tumeric and honey. Just keep adding turmeric. Keep doing it until the honey is thick and grainy and not even really sticky any more. Mix until any more turmeric you add just stays as powder on the top of the honey, doesn’t get stuck into it anymore. Then you’re done. 

One little teaspoon of that in a big milky cup of chai tastes AMAZING and gets you way more turmeric than a tiny little shitty $1.25 pill capsule. Drink that shit and enjoy.

Drugs

Marilyn: “When you’re on a film you’ve got to look good in the morning so you’ve got to get some sleep. That’s why I take pills.”

John Huston: “The girl was an addict of sleeping tablets and she was made so by the goddamn doctors.”

Arthur Miller: “Doctors had gone along with her demands for new and stronger sleeping pills even though they knew perfectly well how dangerous this was…there were always new doctors willing to help her into oblivion.”

According to Donald Spoto, Marilyn began to be addicted to sleeping pills in early 1954, after she took some to combat jetlag-induced sleeplessness. However, the evidence is that by the time she had already been using pills for as many as eight years - Marilyn told Amy Greene that she had been taking pills since the age of seventeen or eighteen. Certainly by 1950, on the threshold of her big break, Marilyn resorted to drugs to combat the overwhelming anxiety she suffered before screen tests. Since 1950 Marilyn had had a ready source of pills from her friend, confidant, and sometime mouthpiece, columnist Sidney Skolsky, who worked out of Schwab’s drugstore and could be relied on to provide sleeping pills and the like. Joe DiMaggio reputedly referred to Sidney and Marilyn as “pill-pals.”

The use of barbiturates, amphetamines, and narcotics was common in Hollywood. It was an exciting and dangerous thing to do, and there was far less awareness of the harmful long-term effects of substance abuse. Drugs ultimately claimed the careers and lived of many famous stars, from Errol Flynn to Judy Garland and Montgomery Clift.

Marilyn used barbiturates, hypnotics, and anti-anxiety drugs. Apart from one documented occasion in 1962, when she met Dr. Timothy Leary, she did not take pills for recreation or thrill-seeking, but as a way of combating her crippling inability to sleep, to calm her frayed nerves, or to tackle the debilitating fear and anxieties which assailed her. Susan Strasberg writes, “People mixed champagne and pills all the time, to increase the effectiveness of the pills. As for Marilyn, she had the burdens of her fear, her timidity, her insecurity and her unusually agonizing monthly periods that rendered her literally incapable of moving.” Once the addictive spiral began, she began to take yet more pills to counteract the effects of other drugs she had taken.

Marilyn was visibly affected by the after-effects of sleeping pills in 1954, when she regularly turned up late and groggy to work on There’s No Business Like Show Business - this was a time of high emotional tension as her recent marriage to Joe DiMaggio was running anything but smoothly.

After escaping the immediate danger of Hollywood and moving to New York in late 1954, Marilyn embarked on a year of self-discovery and acting experimentation, but she still needed sedatives and barbiturates to sleep. She continued to wash down the barbiturates with champagne, hoping that this would give her the chance of a good night’s rest. Eight years later, on the set of Something’s Got To Give, Marilyn was still fraught enough to swallow valium pills with champagne.

Despite warnings about the dangers of her drug abuse, Marilyn seemed unable to cut down her intake except for short periods - there was always some new crisis or her perennial insomnia to bring her back. Gynecologist Leon Krohn warned Marilyn that if she wanted to have children, she should do something about her intake of drink and drugs. After her second miscarriage, Marilyn was consumed with fear that she had brought this on by her intake of Amytal, a barbiturate (medical name amobarbital). By the late fifties, Marilyn was trapped in a dangerous spiral of having to take drugs to sleep, different drugs in the morning to battle through the grogginess, and then take more pills during the day to control her anxiety. Typically, Marilyn scheduled no appointments before midday; the hangover from Nembutal took all morning to clear. 

Marilyn’s dependence on barbiturates and sleeping pills increased even further during tumultuous shooting on The Misfits in 1960. Her Los Angeles doctors sent out stringer drugs, 300 milligram doses of Nembutal (sodium pentobarbital), three times the standard dosage for treating insomnia, and so strong that just seven of these pills would have been enough to kill a person without her tolerance. When she felt that these weren’t enough, she persuaded doctors to inject Amytal directly, in quantities not far off the administered for general anesthetics. In the mornings Marilyn was so groggy that makeup man Allan “Whitey” Snyder had to start making her up while she lay in bed. Rumors circulated that Marilyn had to be walked around her bedroom for hours to get her sufficiently clear-headed, and some biographers write that the only way to get her to actually wake up was to put her in the shower. 

In the last years of her life, Marilyn increasingly switched to chloral hydrate, more commonly known as “Mickey Finn” knockout drops. These were prescribed to her by psychoanalyst Ralph Greenson in an attempt to reduce her dependency on the barbiturates she habitually took. Greenson apparently also prescribed Dexamyl, a potent combination of Dexedrine (a now banned stimulant) and amobarbital, a barbiturate. He remarked in correspondence that her dependence was such that she resembled an addict, yet “did not seem to be the usual addict.” There were times, though, when her behavior was very much that of the addict, seeking new ways to administer the drugs she craved, including injection. Reputedly in the last month of her life, Marilyn’s regular doctor, Dr. Hyman Engelberg, attended Marilyn almost daily to give her so-called “youth shots,” which altered her mood and gave her redoubled energy. 

On August 3, 1962, just two days before her death, Marilyn had two prescriptions for Nembutal, her regular barbiturate sleeping pills, filled at her local pharmacy, from two different doctors (Dr. Engelberg and Dr. Seigel) at the San Vicente pharmacy on 12025 San Vicente Boulevard. 

On her last day alive, Marilyn probably took pills of phenobarbital and chloral hydrate. By mid-afternoon that day, she was seen on the beach walking with a little difficulty, and her speech was slurred. The autopsy showed levels 10 times the normal dose of the first drug and 20 times the normal dose of the second drug: blood levels of 4.5 mg Nembutal and 8 mg of chloral hydrate, and a much higher concentration of 13 mg of Nembutal in Marilyn’s liver. Disparities in these figures have been used to support allegations of foul play in Marilyn’s death and speculation that the lethal dose of drugs was administered either by injection or by enema. Controversy has even surrounded the exact list of drugs that Marilyn had in her bedroom at the time, with some commentators suggesting that only half of the pill bottles found on the bedside table were ever listed by the coroner on his toxicology report (Librium, Nembutal, chloral hydrate, Phenergan, and others without labels).

- The Marilyn Encyclopedia by Adam Victor.

Clinical Trial Offers Hope to Restore Limb Function in Man with Complete Cervical Spinal Cord Injury

Physicians at Rush University Medical Center became the first in Illinois to inject AST-OPC1 (oligodendrocyte progenitor cells), an experimental treatment, into the damaged cervical spine of a recently paralyzed man as part of a multicenter clinical trial.

Dr. Richard G. Fessler, professor of neurological surgery at Rush University Medical Center, is principal investigator for the Phase 1/2a, multicenter clinical trial involving AST-OPC1 at Rush, one of six centers in the country currently studying this new approach.

Fessler injected an experimental dose of 10 million AST-OPC1 cells directly into the paralyzed man’s cervical spinal cord in mid-August. These injected cells were derived from human embryonic stem cells. They work by supporting the proper functioning of nerve cells, potentially helping to restore the conductivity of signals from the brain to the upper extremities (hands, arms, fingers) in a recently damaged spinal cord.

Interim research results from the trial were announced at the 55th Annual Scientific Meeting of the International Spinal Cord Society (ISCoS), which was held in Vienna, Austria, on September 14-16, 2016.

“Until now, there have been no new treatment options for the 17,000 new spinal cord injuries that happen each year,” says Fessler. “We may be on the verge of making a major breakthrough after decades of attempts.”

The next phase of the clinical research trial will involve a dose of 20 million oligodendrocyte progenitor cells, which is the highest dose being studied in this study involving patients who have recently suffered a complete cervical spinal cord injury.

“These injuries can be devastating, causing both emotional and physical distress, but there is now hope. In the 20 years of my research, we have now reached a new era where we hope to demonstrate through research that a dose of very specially made human cells delivered directly to the injured site can have an impact on motor or sensory function,” says Fessler. “Generating even modest improvements in motor or sensory function can possibly result in significant improvements in quality of life.”

Early research results from the trial were announced at the 55th Annual Scientific Meeting of the International Spinal Cord Society (ISCoS), which is being held in Vienna, Austria, on September 14-16, 2016.

“Our preliminary results show that we may in fact be getting some regeneration. Some of those who have lost use of their hands are starting to get function back. That’s the first time in history that’s ever been done,” says Fessler. “Just as a journey of a thousand miles is done one step at a time, repairing spinal cord injuries is being done one step at a time. And, now, we can say that we’ve taken that first step.”

The clinical trial is designed to assess safety and effectiveness of escalating doses of the special cells (AST-OPC1) in individuals with a complete cervical spinal cord injury. Thus far, three individuals have been enrolled in the study at Rush.
The trial has involved the testing of three escalating doses of AST-OPC1 in patients with subacute, C5-C7, neurologically-complete cervical spinal cord injury. These individuals have essentially lost all sensation and movement below their injury site with severe paralysis of the upper and lower limbs. AST-OPC1 is administered 14 to 30 days post-injury. Patients will be followed by neurological exams and imaging methods to assess the safety and activity of the product.

“In the future, this treatment may potentially be used for peripheral nerve injury or other conditions which affect the spinal cord, such as MS,” says Fessler.

For this therapy to work, the cord has to be in continuity and not severed, according to Fessler. The study seeks male and female patients ages 18 to 65 who recently experienced a complete cervical spinal cord injury at the neck that resulted in tetraplegia, the partial or total paralysis of arms, legs and torso. Patients must be able to start screening within 25 days of their injury, and participate in an elective surgical procedure to inject AST-OPC1 14 to 30 days following injury. Participants also must be able to provide consent and commit to a long-term follow-up study.

The study is funded by Asterias Biotherapeutics, which developed the AST-OPC1 (oligodendrocyte progenitor cells) treatment used in the study, and also in part by a $14.3 million grant from the California Institute for Regenerative Medicine (CIRM).

AST-OPC1 cells are made from embryonic stem cells by carefully converting them into oligodendrocyte progenitor cells (OPCs), which are cells found in the brain and spinal cord that support the healthy functioning of nerve cells. In previous laboratory studies, AST-OPC1 was shown to produce neurotrophic factors, stimulate vascularization and induce remyelination of denuded axons. All are critical factors in the survival, regrowth and conduction of nerve impulses through axons at the injury site, according to Edward D. Wirth III, MD, PhD, chief medical director of Asterias and lead investigator of the study, dubbed “SCiStar.”

lifted // listen here 

1. When I Say I Love U (Saux Remix) - Shy Girls 2. The Love You’re Given - Jack Garratt 3. Manhattan - Gallant 4. Eggshells - Aqualungmusic ft Lianne La Havas 5. Station - Lapsley 6. Worry - Jack Garratt 7. Bridges - Broods 8. False Calls - Klo 9. For You - Fyfe 10. I Got U - Duke Dumont ft Jax Jones 11. Coffee - Sylvan Esso 12. Wild Ones - Bahari 13. Say You Love Me - Jessie Ware 14. Lovers In The Parking Lot - Solange 15. Running With The Boys - Lights 16. Re:stacks - Bon Iver 17. You’re The Best - Wet 18. High Life - London Grammar 19. Resolution - Matt Corby 20. Doses & Mimosas - Cherub 

Preventing and Treating Winter Colds

By Michael Castleman

The signs don’t lie: scratchy throat, nasal congestion, watery eyes. It is, indeed, the start of another cold. If your first thought is to reach for the Airborne, that over-the-counter herbal cold remedy invented by a teacher, think again. It probably won’t make a dent.

But other herbal and natural approaches do prevent colds—and if you do end up catching a cold, natural treatments can spare you considerable misery.  

Colds are humanity’s most prevalent illness. Caused by more than 200 viruses, each one technically causes a “different” cold. But because all colds produce similar symptoms, the malady is considered a single illness. 

Most colds start with a scratchy throat, and progress through nasal congestion, watery eyes and runny nose to a dry, hacking cough that may become bronchitis. Childhood colds may cause fever, but adult colds rarely do.

Medically, colds are minor and clear up by themselves in a week or so. But this minor illness causes major misery and is quite costly. Americans suffer 500 million colds annually and spend $17 billion a year treating them. Most of that money is wasted on over-the-counter cold formulas that suppress symptoms without spurring healing. Herbal and natural approaches are preferable because they provide real protection and/or speed healing.

Keep reading

April 19, 1943, Hofmann performed a self-experiment to determine the true effects of LSD, intentionally ingesting 0.25 milligrams (250 micrograms) of the substance, an amount he predicted to be a threshold dose (an actual threshold dose is 20 micrograms).[8] Less than an hour later, Hofmann experienced sudden and intense changes in perception. He asked his laboratory assistant to escort him home and, as use of motor vehicles was prohibited because of wartime restrictions, they had to make the journey on a bicycle. On the way, Hofmann’s condition rapidly deteriorated as he struggled with feelings of anxiety, alternating in his beliefs that the next-door neighbor was a malevolent witch, that he was going insane, and that the LSD had poisoned him. When the house doctor arrived, however, he could detect no physical abnormalities, save for a pair of incredibly dilated pupils. Hofmann was reassured, and soon his terror began to give way to a sense of good fortune and enjoyment, as he later wrote…
“… little by little I could begin to enjoy the unprecedented colors and plays of shapes that persisted behind my closed eyes. Kaleidoscopic, fantastic images surged in on me, alternating, variegated, opening and then closing themselves in circles and spirals, exploding in colored fountains, rearranging and hybridizing themselves in constant flux …”

The events of the first LSD trip, now known as “Bicycle Day”, after the bicycle ride home, proved to Hofmann that he had indeed made a significant discovery: a psychoactive substance with extraordinary potency, capable of causing significant shifts of consciousness in incredibly low doses. Hofmann foresaw the drug as a powerful psychiatric tool; because of its intense and introspective nature, he couldn’t imagine anyone using it recreationally.[9] Bicycle Day is increasingly observed in psychedelic communities as a day to celebrate the discovery of LSD.