#renal patients

[abybweisse]

hi, what is your idea on why the bizarre dolls need new blood? I know when they brought a dog back to life (in real life), they had to cycle it's blood with a machine. But then they could stop it after its heart could do the process again. Back to kuroshit now, Maybe due to them being a corpse, their blood stagnates. But I don't see why that's important to a bizarre doll? Then again, we don't know much about the nature of them yet..... Maybe soon with the "brass" getting one!!! That's my idea at least. What's yours?

Why do BD's need fresh blood?

This is something I've answered before. I've discussed it a few times, actually. I'll see if I can find links to older posts about it.

Short answer: Othello says something isn't 100% about the process Undertaker is using, and I suspect it's a matter of kidneys that don't work to clean out their blood. That's probably why the same machines are being used for renal failure patients who were making donations to the Aurora Society. Undertaker is possibly trying to perfect the process for reviving humans... not just reanimating them.

I've previously posted that real Ciel might need a kidney transplant, and that our earl might be needed for that. On top of the possibility that Undertaker might want to transplant our earl's soul into real Ciel's body....

At least some of those posts would also mention Josef Mengele, the "Angel of Death" doctor with the Nazis. He was obsessed with doing medical experiments, particularly on twins, and transplants were one of his specialties.

But please check the tags on this post and look around my blog for previous posts about this.

[iheartvmt]

When the two sweet, adorable little kitten siblings come in for their s/n surgeries, but the pre-anesthetic blood work shows mild renal dysfunction, so you do a U/A and it's chockablock full of renal cells and no sign of infection, and then the doctor finds out their breed is predisposed to polycystic kidney disease...

[sweetdreamspootypie]

Plagueblogging / covid nursing 2023

[kirishwima]

welcome to psychiatry residency, where on one average night shift you:

-have to convince a patient to take a urine test, because their urine is NOT yours to take and they want it to remain in their bodies, thank you very much

-are spat on by a patient whose chewing cookies then spitting them out

-nearly fall over a trashcan when trying to deliver a medical report to your ward through the window so that the door opening doesnt wake up all your patients

-accidentally send a fax to the police station approximately 20-25 different times and get a phone call from the cops BEGGING you to stop sending the same fax. Little do they know you have no control over it, it's 2:00 am and the fax machine decided it hates YOU, specifically

-your colleagues outside the psychiatric field beg you to prescribe them antidepressants because all medical personnel is well past the point of burnout and into whole new territories of exhaustion-you included

-eventually you start pleading, out loud, with the fax machine to just stop dialing. The nurses glance your way and shake their head. 'typical psychiatrists', you can almost hear them say

-you receive kindness from one (1) non-psych colleague and want to cry because everyone usually dismisses you like a potato with spuds on it

Join us :D

[mrsballlegs]

Managed to keep my patient alive through the night (ended on a mere 100 of levo 300 of neo and 0.04 of vaso status post cyanokit) but most likely he will be dying on his birthday today I’m just glad it’s not on my shift and that he is DNR

[artisticdivasworld]

Compassionate Care for Chronic Kidney Disease: A Nursing Perspective

Chronic Kidney Disease (CKD) is a progressive loss of kidney function over time. Managing CKD is not just about slowing the progression of the disease but also about enhancing the quality of life for those affected. Nurses play a crucial role in this process, providing care that is as compassionate as it is competent. This blog post will explore the nursing interventions and desired outcomes that…

[yorkshire-rockchick]

First night on night dialysis, 7 hours of doing absolutely nothing whilst pretending to sleep

[healthkidneycarearogyam]

BK Kidney care is providing information about kidney failure, kidney dialysis, Chronic kidney disease. we are treating kidney failure without Dialysis and kidney transplant with the help of Ayurveda.

[lexingtonrenalcare]

Lexington Renal Care is now opened in Lexington, KY Come Visit

Dr. Hazem Kakaji, MD, obtained a certification in both Internal Medicine and Nephrology from the American Board of Internal Medicine. He is located in Lexington, KY, and has over 25 years of experience in the medical field. Dr. Kakaji completed his residency in Internal Medicine at The University of Missouri-Kansas City in 2006. Prior to that he completed his Internal Medicine residency at AUH in 2000, received a Master’s degree in Internal Medicine, and completed a Nephrology and Hypertension Fellowship from the University of Kentucky in 2014. Dr. Hazem Kakaji, MD is affiliated with Baptist Health Lexington and St. Joseph Hospitals. He currently holds membership in the American Society of Nephrology, National Kidney Foundation, and International Nephrology Society.

We manage the following disorders at Lexington Renal Care: Physician in Lexington Renal Care ky

Hypertension Proteinuria and Hematuria Diabetic nephropathy (kidney disease related to diabetes) Glomerular diseases Acute and chronic renal failure Inherited renal diseases (including polycystic kidney disease) Evaluation and management of kidney transplant recipients and donors Disorders of fluid, electrolyte and acid-base Nephrolithiasis (kidney stones) disorders of calcium and parathyroid hormone Osteoporosis and metabolic bone disease Management of dialysis including: In-center dialysis, peritoneal dialysis, home hemodialysis, and nocturnal hemodialysis Managing anemia related to chronic kidney disease

[craftygal65]

Pharmacist-led walk-in clinic opens in Edmonton area

Chris Chacon

Pharmacist-led walk in clinic

Image of ribbon cutting of new Pharmacist-led walk in clinic in Fort Saskatchewan. Chris Chacon/Global News

People in the Edmonton area now have another option when it comes to finding health care. A pharmacist led walk-in clinic opened it’s doors Friday to patients in Fort Saskatchewan.

“I think its wonderful, I think its going to help so many people,” said Sylvia Viczko, who was visiting the store.

Read more: A first for Alberta: Superstore opens pharmacist-led health clinic in Lethbridge

Loblaws opened its first pharmacist-based clinic inside a ‘Superstore in Lethbridge back in June.

This one opened inside a *Shoppers Drug Mart in Fort Saskatchewan’s West Park Plaza.

The clinic works similarly to any other walk-in clinic, except instead of seeing a doctor you speak with a pharmacist who assess your symptoms.

“That ranges from treating things like minor ailments — like if you have a bladder infection, you don’t want to be sitting in the emergency for a number of hours, save that spot for somebody who has a more complex issue — to things like managing your diseases like hypertension, high blood pressure, diabetes and stuff like that,” Shoppers Drug Mart pharmacist and owner, Rajan Bharadia said.

A pharmacist can only treat minor illnesses or injuries and anyone needing more serious medical care still needs to go to a hospital. Pharmacists are also able to prescribe and renew certain medications without the need of having to see a doctor.

“If you don’t have a regular doctor in Fort Saskatchewan you, cannot get into the walk-in clinics the same day or you have to go to Sherwood Park,” Viczko said.

Read more: ‘I urge you to get the flu shot’: Alberta mom whose daughter was intubated in ICU

It’s a much-needed alternative, Viczko said, for the city and surrounding communities.

“I have gone to emergency for something that I don’t feel is emergency care, but that’s the only option I have,” Viczko said.

The city’s mayor said she would like to see more open up.

‘We’re hearing from citizens all over the province that they can’t get in to see a doctor, the walk-in clinics are fully booked, go to emergency and they wait 10 hours. That’s not acceptable,” Mayor of Fort Saskatchewan Gale Katchur said.

Read more: Alberta’s health-care problems decades in the making

“Even if it’s not something we can deal with under our scope of practice, what we can do is direct you where to go. Also, maybe communicate with your other health-care providers and that circle of care to help you get care quicker,” Bharadia said.

An option Bharadia said he’s happy to help provide, given the challenges facing our healthcare system.

‘I think that is fabulous, it’s long overdue,” Viczko said.

What about Nurse Practitioners? They’re really under utilized. I have a nurse practitioner who I adore. She’s helped with some of the most difficult times during hospital stays.

[shinynewboots]

Hazbin Hotel Characters as Medical Specialties

Charlie: Pediatrics

You're telling me can't imagine Charlie with Bluey stickers in her pocket and saying "oh I see a dog in your ear. Woof!" When using an otoscope on a child with an ear infection? Be so for real rn

Vaggie: Emergency Medicine

This woman thrives in chaos, she grew up on a battefield. The ED is the Wild West of medicine and Vaggie thrives under the constant stress and variety

Vaggie: "what do you mean you were woodworking while drinking, are you fucking stupid"

Vox: Nephrology

Okay, okay this one is less based in personality and more based in the fact that I need to see a pissing competition between Vox and Alastor (as a cardiologist) about fluid status and renal function

Vox: *decreases lasix dosage in a patient with poor renal function*

Alastor: *punches Vox bc that patient is also fluid overloaded and has heart failure with a reduced ejection fraction*

Velvette: Dermatology

Listen you can't tell me that she didn't have amazing skin when she was alive. I can see her moving more towards the cosmetic side of dermatology with occasional biopsy or Mohs bc who doesn't love a procedure every once in a while

Cherri: ICU/Crit Care

Like Vaggie, Cherrie also thrives in chaos and things in the ICU can go from 0 to 100 in less than a minute. I also feel like she would have pretty good empathy and separation of work and home to be able to not let the job get to her too much

Angel: Psych

This just feels perfect to me, more based on my own experience but everyone I've met in Psych is kind while also being the coolest person you've ever met. I also think Angel would really be able to empathize with his patients based on his own history with addiction. He really likes to listen and offer support and advice.

Alastor: Cardiothoracic surgeon or Cardiologist (to get into a pissing contest with Vox about fluid and sodium)

Look, I know Al is like the perfect surgeon. He's intimidating, meticulous, and calculating. And I don't disagree, I think he would thrive as a CT surgeon...however, there's just something about him arguing with the nephrologist that just gives me the giggles

Lucifer: Internal Medicine

Listen, he's done it all and seen it all. He will spend hours rounding because he just wants to make sure he gets everything right (he's also avoiding going home alone but that's a different story). He also loves working with medical students and will give rousing lectures on first-line antihypertensive and diabetes medications (while also getting all of the students and residents names wrong).

Lute: OBGYN

Listen, I love Lute but if I knew her in real life she would intimidate me so badly. Much like the OBGYN attendings I worked with. She's amazing at her job and beloved by her patients for her blunt yet realistic recommendations, but in her L&D room or operating room, that is her domain and there is no deviation from that. Medical students and residents should exercise caution, but she will teach them the most out of any rotation

Adam: Orthopedics

This man is an ortho bro if I've ever see one. He is the attending who will pimp medical students on the playlist he has playing in the OR instead of the surgery in front of them. (What do you mean you don't know what artist this is? It's the fucking Eagles. Go home and study up, we're playing Led Zepplin tomorrow.)

Niffty: Pathology

Listen I have no explanations for this one. It just felt perfect, tbh

Husk: Anesthesia

This man is like every anesthesiologist I've ever met. He is there stereotype and sits behind the current with his sudoku in hand. Don't let that fool you, this man has knowledge and skill and is not afraid to use. The second your patient starts de-sating or coding, he's the one you wanna listen to

Rosie: Family Medicine

Rosie is the picture-perfect family medicine attending. Kind, empathetic and offers great advice. From cradle to grave, she's got you covered with primary prevention and screening and will be there for you for whatever comes next

Lol this is meant in good fun, so there are a few stereotypes about the different specialties and a lot of it is based on my own experiences on rotations. Let me know what you guys think. I know I missed some characters so let me know if y'all want me to come up with more.

[macgyvermedical]

Let's Talk ESRD and Dialysis

Have you thanked your kidneys today? Do you feel grateful when you pee? How about when you eat a little too much potassium or drink a little too much water, do you really enjoy feeling confident that your kidneys will just dispose of the excess?

If so, you probably know the alternative.

About 10% of the world's population has a condition called Chronic Kidney Disease, or CKD. About 2 million of those people are in End Stage Renal Disease (ESRD) and require dialysis or a kidney transplant to live.

Your kidneys are amazing things. They are two organs that sit outside of the sac that hold the rest of the abdominal organs, called the peritoneum. They take in blood from the body, determine the levels of electrolytes, water, and waste products in that blood, and remove the waste products and excess electrolytes and water.

They also have secondary tasks. They monitor the amount of red blood cells in your blood and send out hormones that entice the bone marrow to make more when we're low. They also monitor blood pressure and release hormones that raise that blood pressure when it gets low.

Lots of things can hurt the kidneys. For example, poorly controlled high blood pressure and poorly controlled diabetes are among the top reasons why kidneys fail. Additionally, being dehydrated while engaging in strenuous exercise or taking medications like ibuprofen or naproxen (any NSAIDs) can cause kidney damage.

We measure how well the kidneys are working via the Glomerular Filtration Rate, or GFR. This is a measure of (essentially) how much blood in milliliters the kidneys filter per minute. 90 or higher is normal, while a GFR of 15 or lower is considered ESRD.

So let's say someone has a GFR of less than 15 and the decision is made to start them on dialysis and put them on the kidney transplant list. What options do they have?

Well, they need to figure out if they want to do hemodialysis or peritoneal dialysis.

In hemodialysis, the patient is hooked up to a machine that runs their blood across a special membrane. On the other side of the membrane, a solution called dialysate draws excess water, electrolytes, and waste products from the blood. Hemodialysis is usually done at a dialysis center for 3-5 hours, 3 times per week.

Hemodialysis is better for patients who have either failed home peritoneal dialysis or can't or aren't comfortable with doing the technical part of the job by themself at home. There is also a social component, where dialysis is a chance to meet and interact with other people who are going through the same things they are.

People who undergo hemodialysis have to have some kind of "access", or a way for the blood to come out of their body, go through a machine, and go back into their body. For some people, this is a dialysis catheter that is inserted into the person's chest and looks like this:

It can also be a fistula. A fistula is the surgical connection between a vein and an artery in the arm or leg. Over time, this connection becomes large and rubbery, and each time dialysis is done, two needles (one to remove blood, and one to return it) are placed in the fistula. A fistula often looks like this:

In peritoneal dialysis, the patient instills the dialysate directly into the sac that holds their abdominal organs. The sac itself acts as the membrane, and dialysate draws the electrolytes, water, and waste directly through the sac wall. They then wait a certain number of hours, and drain the dialysate. This can be done manually by the patient during the day, or at night while the patient sleeps with a machine called an automatic cycler. Usually peritoneal dialysis is done every day, with 2-4 cycles of 4 hours per cycle.

People using peritoneal dialysis also need a form of access, but instead of it being to their blood stream, it is to their peritoneum. Here's what that looks like:

The catheter is placed surgically into the peritoneum, and stays there all the time, even in between dialysis sessions.

Someone using peritoneal dialysis has to be very careful when they are accessing their dialysis catheter. This is because the biggest problem with peritoneal dialysis is the risk of a life threatening infection called peritonitis. Someone who gets peritonitis too many times may need to switch to hemodialysis.

Here is what a manual exchange looks ilke:

Someone may choose to do peritoneal dialysis over hemodialysis because it affords more freedom to keep a job or do daily tasks like keeping house. People who do PD also don't have to find rides to the dialysis center. However, they do have to take on more of the responsibility for making sure they do treatments correctly and be able to keep accurate records of the treatments they give themselves. Peritoneal dialysis also tends to be less taxing on the body, and have fewer side effects than hemodialysis when done correctly.

[abybweisse]

Blood Work (p1), Elitism, transmutation, and religious fear

⚠️ long post ⚠️

So, I now have a copy of Blood Work: A Tale of Medicine and Murder in the Scientific Revolution, by Holly Tucker. It's a reference for Yana-san, as she mentioned it in her old tuna.be blog around the start of the blue arc.

I see in the list of important people a mention of the real Dr. Moreau, and there's a later chapter about chimeras... so I know I'll be talking about that some, over this series of posts.

It's important here, too, because when researchers were first attempting blood transfusions in the 17th century, people were terrified about receiving blood from animals, like sheep and cattle. They thought that animal blood would transmute humans into human-animal hybrids. Even in the 20th century, some white people were terrified of receiving blood from black people, because they thought the blood could effect the race of their future children or grandchildren. Nonsense, of course, but they didn't understand.

17th century blood transfusions were generally performed by taking blood from a lamb or a calf. The barbers/physicians/researchers had no clue about blood types. Jean-Baptiste Denis successfully transfused blood from a lamb into a teenage patient. Then he made several successful attempts at transfusing from a calf to a "madman". The guy later died, and Denis was blamed. Turns out some doctors who didn't want him to succeed had actually poisoned that second subject with arsenic.

It wasn't even a matter of those physicians wanting his experiments to fail while theirs worked; no, they simply didn't want blood transfusions to become a practice. They were afraid of transmutation from animal blood, and they were afraid of what animal-to-human blood transfusions would reveal about humanity -- that we are truly just animals, too. The trial against Denis ended research into blood transfusions for about 150 years.

Blood types were still unknown in the late 18th century, when a physician wanted to attempt to revive George Washington's largely exsanguinated corpse with a transfusion of lamb's blood. FYI, he died on a December 14th, just like Prince Albert. His family refused the offer only because they feared sullying his body with animal blood, and they insisted his body must be left untainted and wholly together for him to be properly received into heaven. Such was the continued lack of understanding. Yana-san might have given Undertaker the idea to use blood transfusions in conjunction with other techniques for the reanimating and revival process from the account of what that physician wanted to do to Washington.

When blood transfusion research was in full swing, in the 19th century, they were starting to piece together the idea of blood groups, but they still didn't quite know about things like universal whole blood donor and universal whole blood recipient. There was a strong elitist element to this, so they generally thought like could only be compatible with like. They also still saw non-human blood as inferior, even if it might be compatible. The best compatibility was expected between twins and then between close relatives.

I have a feeling that Yana-san has played around with this bias, which would explain why real Ciel is only receiving AB (Sirius) blood, Canopus B, Vega O, and Polaris A. All those people at Sphere Music Hall are led to believe they are being treated as equals, when they are in fact being split up into a caste system where some "stars" are of a higher magnitude than others. And, at times, Blavat Sky and others have made it clear they see some blood types as being less worthy than others. By extension, some people are treated as less worthy. Blavat seems to realize that Sirius can receive blood from other blood types, because he gives "leftovers" of Vega and Polaris blood to the Sirius renal patients. It's possible that real Ciel doesn't know he can have any type of whole blood, but I suspect he knows and simply doesn't think anything else is good enough for him.

I'd also like to mention Snake and Finny here, since we know Finny was injected with something to increase his strength and other traits. Then we see Snake with various attributes that are associated with snakes. In either case (or both) we could be dealing with transmutation. It's not realistic in our world, but it might very well be possible in theirs. Each of them might have been injected with chemical cocktails derived from other animals: Snake from snakes and Finny from perhaps a few completely different species.

We now know Snake wasn't born a snake and turned into a human, but there's nothing to say he wasn't born human and "adulterated" with snake traits. There's also the weird story the freak show attendant claims: human mother and snake father. Maybe not an actual snake as his father but more like his mother being injected with snake blood or something... and that producing a hybrid child. Again, not what we'd consider possible, but the Kuroverse plays by different rules.

One other aspect I want to touch on in this post: Othello's and Grelle's fears regarding the very nature of human souls and existence. This is a form of religious fear, not too different from what George Washington's family feared. His family feared he wouldn't be accepted into heaven, while these two reapers fear humans might no longer even need souls, and that heaven may no longer matter to them. What would that mean for the existence of reapers, when their supposed salvation requires them to keep collecting souls?

Well, I'll probably talk about bias and fear again, as well as these other issues, but I'll stop here... for now.

[appalachiananarchist]

The 15 minute clinic visit model should be considered a crime. Do you really think you can adequately address a patient's A1C of 11.5 (while they refuse to adhere to a diabetic diet or take their meds, so you have to explain why these things are important and that no, Metformin did not cause Uncle John to develop Rheumatoid Arthritis), blood pressure of 187/98, ongoing chest pains, chronic back pain, inability to sleep, explain to them what it means to have chronic kidney disease and what meds they need to avoid + go through their current meds to renally dose them, update their foot and eye exam, and talk about changing the medications for their bipolar disorder... in 15 minutes?

Keep in mind the patient keeps interrupting to tell you about their sister Shirley's birthday party and ask irrelevant questions like, "Hey doc, is it true going outside in the cold gets you sick? Is it true babies don't have bones?"

Oh, and the patient reminds you as you think you're wrapping up that they need you to check their shoulder because they fell on it yesterday and also they think they have a sinus infection...and then you remember you haven't reviewed their health maintenance gaps yet, either.

The above is not a hyperbole. This is the average patient I see in my clinic as a rural family medicine doctor. I have people fitting this profile scheduled every 15 minutes because it is our health system's standard policy. It makes me furious because these patients deserve to have all of their issues addressed, but it is not possible. They taken time off work, some of them driving over an hour, to see me. These are serious problems and serious misunderstandings that deserve my full attention for as long as is required, not to have me rush, half addressing their concerns or not addressing them at all.

We can't be doctors in this system. We are just little reimbursement machines.

And the icing on the cake: after you talk to the patient and finally compromise on medications the patient agrees to take, the insurance company denies them all.

[batbusiness-schooldropout]

Sometimes I think that miscommunication among the batfam is unrealistic because surely these guys understand how important it is.

But then I remember that at least one a day we have to have an argument with a nurse asking where food is for a patient and we have to tell them they have to but in a diet order. No diet order, no food. For all we know, the patient is diabetic, renal diet, NOCHOL, NPO, and allergic to everything but milk and egg yolks

So yeah, it's entirely believable that those idiots don't talk to each other about stuff

[elvis1970s]

Fairytale, a Pointer Sisters cover, was recorded by Elvis in early 1975 and featured as an album track on Today, released in May of that year. It would remain in the live set right up to the end. This joyous version was captured in a good quality audience recording during Elvis' dinner show in Las Vegas on August 20th, 1975. He's in such great form that it's actually quite hard to believe that following the second show that night, the engagement would be abruptly cancelled (just three nights in) and Elvis would be flown back to Memphis and admitted to hospital.

United Press international (UPI) issued a syndicated report on the sudden cancellation;

“…He just got very tired and fatigued and we thought it would be best if he cut his show here short this time rather than run into complications," said Dr. Elias Ghanem, the singer's Las Vegas physician. "We can't find much wrong with him. One of the liver enzymes is elevated and what he needs is rest…”

Dr Ghanem (1939-2001) enjoyed an enviable lifestyle from his business activities and from billing a number of wealthy and undoubtedly generous Las Vegas entertainers for treatment of, amongst other things, ‘Vegas Throat’ – raspy soreness caused by a combination of the dry desert air and the air-conditioning (and passive smoking) within the hotels and casinos. He was also a proponent of the sleep diet; a regimen of weight loss that appeared to involve the patient being sedated for much of the time and consuming liquid nutrition during rare moments of consciousness. Elvis himself had availed himself of this regime on at least one occasion.

The Irish Times wrote an obituary for Dr Ghanem upon his death from renal cancer in 2001.

“…He was Elvis Presley's personal physician, as well as the doctor for Elvis's posthumous son-in-law Michael Jackson. Although his patient list also included Liberace, Bill Cosby, Ann-Margret, and Virginia Kelley (the mother of former President Bill Clinton), it was Ghanem's relationship with The King which first brought him under the spotlight of unwanted notoriety. When ABC's television programme '20-20' reported that he had supplied the drugs which essentially killed Presley, Dr Ghanem threatened to sue - but he never did…”

The article also noted that Ghanem had been the subject of an FBI investigation over billing, but never charged, and that Colonel Parker had a financial interest in Ghanem's clinic situated conveniently adjacent to the Las Vegas Hilton.

"...Ghanem expanded his practice to include a chain of clinics around Las Vegas, treating literally thousands of patients. He proposed innovative umbrella health-insurance schemes long before they came into vogue, and signed contracts with the Hotel and Casino Workers' Union, by far the largest group of workers in Nevada. The arrangement was obviously a profitable one for Ghanem, but union leader John Wilhelm, recalled that during a protracted six-year strike at the Frontier Casino, Ghanem treated every worker free of charge and delivered over a hundred babies for the striking workers..."

Following the cancellation, Elvis was flown back to Memphis where he was admitted to a private suite on the top floor of Baptist Memorial Hospital. His next professional engagement was back in Las Vegas in December making up for the cancelled shows.