Its all about the response time.

There's a maxim in EMS about the "golden hour".  

In general, across a broad spectrum of traumatic (and some medical) issues, EMS has 1 hour from inception until Emergency Room arrival and that every minute after that hour degrades the patient possibility for a positive outcome.  

The concept has been, for the most part, proven to be inaccurate, but it still lingers in EMS training and in EMS methods.  

In Dubai, they're trying to address the issue with 160 mph first responder sports car.

As this article points out, “Overemphasis on response-time interval metrics may lead to unintended, but harmful, consequences (e.g., emergency vehicle crashes) and an undeserved confidence in quality and performance,”  but it's GREAT for PR.

Coffee.

Coffee.  

You need it.  

Well, maybe you don't, but I do!

Here's a fascinating (and short!) article from Scientific American about the evolution of caffeine producing plants...arabica, robusta, tea, chocolate...



So how DO you get your caffeine fix?  Coffee?  Chocolate?  Soda pop (ick)?  Energy drinks (double ick!)?  Tea?

Oh...and did you know that black tea is nothing except oxidized green tea?  Just like rust is oxidized iron....black tea is oxidized green tea.   And Oolong is half oxidized.

Its thought that the practice started because black tea will retain it's flavor much longer, making it suitable as a trade item.

Enjoy!

8. Active social life.

Last, but not least, in our list of 8 things you can do to improve your overall wellness is to lead an active social life.


As this article points out, if stress is the villain of the story, then an active social life is the hero.

An active social life has been shown to delay dementia, Alzheimers and other age related disorders.

Whether volunteering in your community, taking adult ed classes at a school, bowling, bingo, square dancing, joining a writer's or reader's group, it's good for you.

And no, I don't think playing farmville on facebook is quite what the researchers have been looking into...

7. Reduce stress

We've written before about the value of optimism and meditation. 

It's long been known that some stress, acute stress, can be good for you.  

We evolved to run from giant predators.

But chronic stress, long term stress, is terrible for you. It accelerates aging, contributes to dementia and Alzheimer's, increases the severity of cardiovascular disease.

Eliminating chronic stress is one of the most successful methods you can adopt for increasing your overall health.

Exercise, meditation, gratitude practice:  there are a lot of mechanisms to help you deal with stress.  Find one that works for you.

Ebola - should you worry?

The Ebola virus is incredibly virulent, killing 50-90% of those that have become infected. 

There's no vaccine and there's no cure.

Should you worry that we're bringing a patient back to the US?  This article suggests that no, the facility was built to contain diseases far more infectious than the Ebola virus.

Is this the worst known Ebola outbreak in history?  Yes, it appears to be...but I encourage you to browse this quick article about Ebola...it's not all doom and gloom.

6. Quality Sleep

Quality sleep.  

You need it.   

We've written about it before, but good quality sleep is one of the most effective mechanisms for keeping your body and your life on track.

And you might want to check out this article about surprising signs that you're sleep deprived.

9-1-1 friday fun

You know the emergency number.  But how did it BECOME the emergency number?

Here's a fun article from gizmodo about how 911 became our national emergency line.

In the meantime, some facts:

• The first call to 911 in the United States: Haleyville, Alabama on February 16, 1968. The person who placed the call was Senator Rankin Fite.
• Nome, Alaska, established the country’s second 9-1-1 emergency system only a few weeks after Haleyville
• Great Britain was the first country to establish a universal emergency number (999) in 1937
• An estimated 200 million calls are made to 9-1-1 in the U.S. each year.
• 99% of the population is covered with 9-1-1 service

9-1-1 calls should be reserved for true emergencies.  Otherwise, you might end up here or here.

<- or here.

 

5. Keep mentally stimulated.

Learn to play a musical instrument, a new skill, a new language.

Keep actively engaged with learning new cool things.  It's now well documented that staying engaged and lifelong learning can stave off cognitive and memory decline.

Watching TV doesn't count.  It's got do be doing something where you participate, engage, get involved.  

So no, TV doesn't count...not even if you're throwing things at it.

Music.

Yes, another post about music.  And it won't be the last.

I take it as given that when music no longer moves you, you've lost something irreplaceable.

A friend of mine volunteers in his community by playing guitar in a hospice.  This article is from a friend of his also working with the elderly and music

If You Had Dementia, What Songs Would Be on Your Playlist?

So pick up that instrument you played in Junior High.  Or pick up another.  Or just sing.

If nothing else, turn off the tv and turn off the talk radio: that stuff isn't helping you.

Turn on some music and let your soul fly free.

MERS

Medical Staff and Managers

MERS Daily Briefing

Patient Status Update

The patient is no longer on supplemental oxygen, is eating well and generally improving.  The patient is expected to be discharged soon.  Discharge planning will include the CDC regarding ongoing monitoring and future travel plans.

Hospital Staff and Physicians Update

Hospital staff who were exposed to the patient (prior to the patient being placed in isolation) remain in home isolation and continue to be monitored daily.  All of the exposed healthcare workers have tested negative for the MERS virus.

Highlights from the Press Conference

Today we hosted a national press briefing at the hospital.  The focus of the press conference was to highlight the collaboration and joint efforts of the Hospital, the Centers for Disease Control (CDC) and the Indiana State Department of Health (ISDH) in recognizing the virus and containing the exposure to the public.

Speaking at the press briefing were Don Fesko, Dr. Daniel Feikin, Medical Epidemiologist of the CDC, Dr. William VanNess, Commissioner of the ISDH, Dr. Alan Kumar, Chief Medical Information Officer, and Governor Mike Pence.  The Governor, the ISDH and the CDC representatives all recognized the tremendous efforts and great work provided by the hospital.  Dr. VanNess assured everyone that the public is safe, and noted that based on the fast action of the hospital and through the cooperative efforts of the hospital, ISDH and CDC, “MERS picked the wrong hospital, wrong city and wrong state to try and gain a foothold.”

Governor Pence emphasized the collaboration of the State and Federal agencies, and stressed the safety of patient care at the hospital.  Governor Pence again praised the hospital for its recognition of this rare disease and fast action to contain the situation and protect the public.  Governor Pence asked the audience to give a round of applause to the hospital and the medical staff for their exemplary work in this situation.  He expressed his confidence that the fast actions of the hospital, ISDH and CDC prevented any outbreak of MERS.

All of the participants emphasized the safety of the hospital and that there is no risk to the community at large.  Follow up media interviews will be occurring with Dr. Kumar and the CDC.

Provided by:  

Tom Bettenhausen, NREMT-P

Chairman & Strike Team Leader - IDHS District 1 EMS Element

Secretary - Indiana District 1 Hospital Emergency Planning Committee Inc.

EMS Coordinator

Community Hospital

Additional infomation on MERS 

4. Eat Well.

No, I'm not gonna get all vegetarian, organic, macrobiotic, live on brown rice...and I'm not going to get all paleo, atkins, no carbs on you either.

I'm just going to say you could eat better.  You know it, I know it and your mother knows it too.

The closer you can eat to the source, the better off you are.  Food created in factories isn't really food.  

Sometimes, even when it looks like food, it's not food.  You probably heard that Subway just vowed to quit putting azodicarbonamide into their bread.  That's right...the same stuff they make those yoga mats out of....Subway's going to stop putting it in their bread.  There are about 500 other food products that use it, but Subway is quitting.

Check the bread you bought at the store, does it contain azodicarbonamide?  I don't care if the FDA says its not a health concern, I don't think eating a yoga mat is something I want to do. 

I won't caution you, though, to simply stay away from things you can't pronounce.  Here's a link where a chemistry professor shows you what a food label on common fruits and vegetables would look like. 

Sometimes, frozen foods can even be more nutritious than fresh produce.  Cheaper too.

So that's our 4th guideline to good health.  Eat well: stay away from the crap, eat lots of different fruits and vegetables, ignore fad diets. 

You can thank me later.

3. Exercise

You don't have to run a marathon and you don't have to join a gym.

But good health requires exercise....getting your heart rate up, optimally, for a minimum of 30 minutes a day.  Don't look at me that way: no matter what your age or lifestyle or health condition, you can do something.

And yes, simply walking briskly counts.

Exercise will make you happier, make you smarter and give you more energy.

Exercise is good for younger folks but it's particularly important as we age.

Lastly...I understand that many of us think that we don't have 30 minutes a day to radically increase the quality of our lives.  So let's shoot for something more manageable, like 10.  Can you spend 10 minutes a day to feel better, get smarter, get more energy, be happier?  10 minutes?  Come on, sure you can.

2. Treat underlying medical conditions.

It stands to reason that you're not going to have optimal health if you let some chronic disease go untreated.

I'd like, though, to suggest that you do more than simply treat a chronic medical condition. I'd like to suggest that you take some time and understand it.   What causes that disease, what is done about it, why does that work? 

Don't just turn your situation over to a doctor: take responsibility for understanding what's going on with your body.

If you have atrial fibrillation....what is it?  What's going on with your body?  What are the symptoms?  What is the risk of not treating it?  What's the difference between a beta blocker and a calcium channel blocker?  What are the side effects of those medications?

Every possible condition, disease or illness has a website.  The CDC is an excellent source of information.  Ask your doctor questions.

All the pharmaceutical companies have websites where you can review their drugs, what they do, side effects...usually in pretty simple to understand language.

Whether it's AF, hypertension, diabetes, thyroid imbalances, whatever your particular chronic condition: make yourself an expert.  It's your body, it's your life.   

Your doctor understands medicine, but they'll never understand your body as well as you do...you've lived in it forever.  So get involved, educate yourself, show an interest.

1. Avoid environmental toxins

In our list of 8 items to maximize your health, we'll start with Avoid environmental toxins.

I'm not going to get into genmod corn or fluoride in your water, you don't need to be a chemist or read an obscure scientific paper...just use that thing between your ears for more than a place to put your hat.

If you smoke, stop.  You know it's not good for you, you don't need statistics and warning labels.  Smoking is bad: stop.

If you're in your workshop sanding or playing with your hobbies or painting a room, wear a mask.  If you're spraying hairspray or deodorant, don't breathe.  If fact, why don't you quit using that spray can stuff altogether?  Common sense...if you're coughing, then stuff that's not good for you is getting in your lungs.  Yes, masks are inconvenient.  So is emphysema.

Wash food before you eat it.  You know that farmers use herbicides and pesticides.  You know those are poisons.  The only reason they use them is to kill things.  

Stop using pesticides and herbicides yourself.  Yes, we all want a green lawn without crabgrass.  But the stuff you're spreading is poison.  And you were out there spraying it on your lawn, wearing your flipflops, with the grandkids coming over to play.

Yes, I know the label says "safe for humans"....and they used to treat headaches with leeches.

Poison: they make it to kill things.  Stay away from it.  Keep your kids and grandkids and pets away from it.

If your work requires some type of personal protective gear, use it.  Not just when the boss is watching, but all the time

You can eliminate a huge amount of toxins just by paying attention and using your common sense. 

Live well, my friends.

Show me eight fingers.

You don't even need your thumbs.  Eight fingers are all you really need to count off the big ticket items to optimal health.

In upcoming weeks, we'll go over them individually, but let's start by putting our list together.

1.  Avoid environmental toxins. Quit smoking, wear a mask when around dust, wash food before eating, that kind of thing.

2.  Treat underlying medical conditions. Diabetes, obesity, heart disease, high blood pressure....whatever it is, take care of it.

3.  Exercise.  Every single day.  You don't have to run a marathon, walking counts.  But you have to move, stretch, loosen up the muscles, get the heart rate up.

4.  Eat well.  We're not going to get into all that organic or vegetarian stuff here, but eat a balanced diet of foods that don't come from factories.

5.  Keep mentally stimulated.  Don't spend all night watching tv or clicking "like" on facebook.  Learn something new.  Learn to play a musical instrument, memorize a poem, get a new hobby...something you're doing instead of something the people on tv are doing.

6.  Get quality sleep.  We posted a couple weeks ago....sleep restores you physically and mentally.  It's important.  

7.  Manage your stress.  Yoga, golf, bowling, workout, whatever.  Stress isn't just mental, it's hard on your body.

8.  Have an active social life.  The numbers are irrefutable, people with an active social life are happier, more engaged, more resistant to depression, live longer and hold off dementia better than their more isolated counterparts.

It's that easy.  It's not magic, there's no prescription or pill.  Just the same common sense stuff your grandmother probably told you.

Live long, my friends and please, live well.

What's it like to be a doctor

An interesting article from Forbes.  Short and well worth your time to read.

Say it ain't so!

Men are the weaker sex?!?!

According to this compilation from Scientific American, with the exception of muscle mass, men are weaker across almost every criterion than women.

Our immune systems are weaker because we have less estrogen.

Males are diagnosed with autism spectrum disorders 4-5 times more than females.

We're more susceptible to environmental poisons like lead and plastic.

We die sooner.  Except in Nepal...it's the only country in the world where men live longer than women.  Strange.

And the list goes on and on.  

There are 106 boy babies born for every 100 girl babies....but it doesn't appear that's going to be enough.  Men are going to end up on the endangered species list!

One good thing about music,

When it hits you,

you feel no pain.






The use of music in healing goes back as far as Plato and Aristotle.  It's use in our more "scientific" era goes back, at least, a couple hundred years.

More and more, the medical community is beginning to explore the power of music...to ease emotional problems, to lessen anxiety in dementia patients, to reduce chronic pain.

It's everywhere: 

• Persons in Correctional & Forensic Settings
• Response to Crisis & Trauma
• Alzheimer's Disease
• Young Children
• Mental Health
• Music Education
• Medicine
• Special Education
• Individuals with Diagnoses on the Autism Spectrum
• Pain Management
• Increase circulation, helps regulate blood pressure.   

  

There seems, no end these days, to the positive benefits of music.  In some cases, medical science is beginning to understand how it works.  In other instances they don't have a clue...but the results are statistically significant and the results uncontroversial.

So add some music to your daily essentials:  eat right, sleep well, exercise....and listen to your music.

I'll see you next week.

Hot off the press!

Please join me in welcoming Dr Marianne Nelson as our new Medical Director.

Dr Nelson has been involved with Emergency Medicine since 1985 and comes with a whole long list of credentials for cardiac, trauma, pediatrics, neonatal, and on and on.

She's actively involved in Emergency Medicine, ICU, CCU and Quality Review processes.

All ambulance services run under the authority and on the medical license of a certified Medical Doctor; Southern Jasper County Ambulance Service is pleased to be associated with someone so involved and experienced with Emergency Medicine.

Mind over matter

Ernest Shackleton once said that "optimism is true moral courage."

And nowhere is that more true than when beset by ill health.

More and more, though, we're discovering that a positive mental attitude can be one of the most significant medicines.

This report, from Science Translational Medicine and NPR show that up to half of a drug's efficacy is simply believing that it will work.  That medicine actually works better if you think it's working.

Optimism can physically change your health.  Specifically:

• lower your odds for heart disease by 30  - 50%
• Improve decision-making ability.
• provide Stronger immunity
• cut your risk for a life-threatening stroke by 10%

 

Sure, you can always go with that cynical/ironic hipster thing...but who'd want to?

The glass really is half full.

is a fever good for you?

Well....maybe.

There's growing evidence that reaching for the Tylenol or Advil when you have a low fever might not be the best thing for you.

Viruses, as it turns out, are very susceptible to temperature...and holding a mild fever down might actually keep you sicker, longer.

Not to mention that those medications have side effects and liver damage issues of their own.

No one suggests that a high fever is good, but for a mild fever, letting it run it's course just might be the best medicine.

That being said, health care practitioners suggest there ARE some common sense guidelines as to when a fever is, in fact, not mild at all

• A child under three months has a fever over 100.4 or exhibits any serious symptoms
• A child has a fever over 104 as this can signal a more serious infection or poisoning
• A child has a fever for more than two consecutive days
• The ill person has other symptoms like stiff neck, listlessness, or sensitivity to light
• The person is unable to hold down food for more than a few hours or shows any signs of dehydration
• Person exhibits any sign of respiratory distress (Seek immediate help)
• Person has been exposed to toxins or poisons that may have caused the fever
• Your intuition says there is something more serious going on, even if the child appears fine

Stay healthy, my friends.

Alzheimer's: holding it off.

As mentioned in the first two of the alzheimer's/dementia posts, there is currently no cure for Alzheimer's Disease (AD).  Nor is there a vaccination. And the general consensus is that the disease is acquired 20 or more years before symptoms begin to appear. 

At this point, the best that can be done is to hold off the symptoms.

For many, this is a reasonably successful approach: if the symptoms can be held off, slowed and minimized throughout old age, then the quality of life for those afflicted increases remarkably.  So what CAN you do to slow the progression of AD?

The good news is that it's the exact same regime needed for generic good health.

1. Regular exercise: walking counts.
2. Healthy diet
3. Mental stimulation
4. Quality sleep
5. Stress management
6. An active social life 
7. Treat other medical conditions like diabetes, obesity, heart disease, HBP.
8. Stop smoking

 And when all else fails, there's this:  remove the stigma associated with dementia and AD.  The city of Watertown, Wisconsin has taken on a city-wide challenge to become the nation's first dementia friendly town.  The downtown owners, shopkeepers and waitresses go through training and learn to deal with mild dementia cases...using pictures on menus so patrons can point to what they want and other "assistive" methods.

Healing wounds with sound.

Researchers at Drexel University College of Medicine have developed a method to treat wounds using ultrasound.

This article from Smithsonian magazine gives a brief overview and this press release from Drexel goes into a little more detail.

No one knows why it works....they just know it does.  Very cool.

Alzheimer's - what IS it?

This is the 2nd in our set of posts about Alzheimer's disease (AD).

The short version is this: the neurons and synapses die off and areas of the brain atrophy...those areas of the brain, effectively, wither and die. No one actually knows what causes AD but, it appears significant that, the areas effected are full of amyloid plaques and and neurofibrillary tangles.

 Amyloid plaques and neurofibrillary tangles are both, more or less, small hardened bits malformed proteins.  It's unknown whether they actually cause the death of the neurons and synapses or whether there's something else that causes the neurons to die off and the plaques and tangles are a by-product of that unknown agent.

One way or another, where there was once vital brain tissue, full of neurons and synapses, in AD victims, areas of the brain begin to atrophy and fill with bad stuff.

AD, as far as is known, is irreversible.  The atrophied areas grow and grow, starting with memory and cognition and advancing until the brain actually loses the ability to manage the body.  In my mother's last hours, her brain could no longer control her body temperature...it swung wildly from the mid-90s to 105/106 and back...sometimes within the same hour.

Lastly, when we discuss AD, we're almost always talking about late-onset AD (as opposed to familial or early-onset), simply because it's, by far, the most common kind.  Now, though, there seems to be an agreement in the field that late-onset AD isn't, actually, late at all.  

It's believed that the disease is usually ongoing 20-30 years before diagnosis.  The symptoms simply don't start to show up until much, much later.  As such, finding a biomarker, as discussed last week, becomes of critical importance.  Addressing the disease 20 years before symptoms start could have a dramatic impact on the quality of the victim's lives.


Next week we'll look at the current thinking about how to slow the progress of the disease.

Be well, my friends.  And please: spare a thought or a prayer for the caregivers.

Coming soon...

...to an oncologist near you.

This is very, very cool.  

The problem with cancer is that, essentially, our defenses don't see it as disease...it's our body's own cells growing out of control.

This article gives a brief overview of a new method of "tagging" a tumor so that the body sees it as foreign and the immune system works to take it out like it would any infection.

Alzheimers and Dementia

Any of us that have been close to a victim of Alzheimer's disease knows just how heartrending the condition can be.

I remember, as a young man, when my intelligent and fiercely independent grandmother first began exhibiting symptoms.  On top of the difficulties of the actual disease, she was aware of her decreasing ability to function and communicate....and it distressed her greatly.

I remember her crying with frustration simply trying to ask and answer simple questions...the look in her eyes...the panic, the fear, the frustration....and I remember the doctor telling us the only real hope was that, eventually, she'd be so far gone she wouldn't be aware of her incapacity: she wouldn't be afraid.  

She would diminish, she would decline, she would lose every scrap of her dignity...and the best medicine had to offer was that she would lose her fear.

Now its forty years later and, truly, not much has changed.  We think we know more about how the disease works...maybe a little about how to stall it or slow it coming on; but it's still irreversible.


And it's still profoundly, incredibly sad.


So if we're going to understand this, deal with it, let's start by trying to look at it clinically.  To remove some of the pain and emotion and review what's known, what's suspected and what, if anything, can be done.

 First off, Alzheimer's and dementia are not the same thing.  Alzheimer's is a disease or a condition and dementia is a symptom.  Much like the flu, influenza, is a virus and a fever is the symptom.

You can have a fever for a variety of reasons, not just the flu...and dementia can occur for a variety of reasons, not only Alzheimer's.  Alzheimer's is believed, though, to be responsible for 50-80% of dementia cases in the first world.

At this time, it's believed that there are three distinct types of Alzheimers disease.  

• Familial, which is very rare, less than 1% of the cases.  
• Early On-set, where people are diagnosed before the age of 65, and this is also rare, less than 10% of known cases.
• Late On-set, the most common form, which accounts for more than 90% of all the cases and is believed to strike more than 50% of people over the age of 85.

Lastly, for this week, diagnosis.

At this time, Alzheimer's cannot be positively diagnosed in the living.  An autopsy is required for positive diagnosis. I've read that a biopsy can work as well, but it would seem unlikely that coring a small section of a living person's brain simply to positively identify Alzheimer's, as opposed to other causes of dementia, is a common protocol.

Most commonly a diagnosis of Alzheimer's is made simply by a careful review of the symptoms.  Because this can lead to misdiagnoses, the search for biomarkers or other positive methods of identification will be key, in upcoming years, to understanding, and eliminating this terrible, terrible disease.

In the next couple weeks, we'll expand...exactly what does Alzheimer's do to the brain, how can you slow down it's impact, etc.

Until then, be well, my friends!

And please spare a thought for the Alzheimer's caregivers: if you haven't done it, you simply can't imagine...