Monday, July 23, 2018

My Acute Renal Failure Episode

UPDATE 23 July:(recovering)
In a nutshell...
Fell over
Sore knee +++
NSAID ++
?Staph cellulitis culture and aspirations negative
Admission to ER obs
24 hrs fluclox IV (renal status not yet checked)
Vomiting started but went home
36 hrs vomiting nil oral dehydrated
Readmit IV rehydration
Uhoh! Creatinine 450!!
Oliguric ATN
Renal U/S normal
eGFR 6! (Was 90 in January)
Creatinine peaks at 750 almost dialysed
Hypertension 190/110
Sinus Bradycardia HR30 monitored in CCU
Improved a bit, but caught severe cold ?flu
Deteriorated clinically can’t eat
Labs improving
Cold settling
22/07 feeling a bit better and eating a little (looking like Thai cave boy after no food for 12 days).
eGFR 15 (20% of normal)
Now: able to do a few emails, walk 100m, reading a book. Updating this blog.
๐Ÿ˜ข๐Ÿคฎ๐Ÿ˜ฌ๐Ÿฅ“๐Ÿณ๐Ÿฅž๐Ÿคž

23/07 

04/08 eGFR up to 35, Urea and Creatinine 2x normal.  Regaining strength.

Monday, February 19, 2018

Gastric Cooling for Bleeding Ulcers (in 1965)

I just uploaded a finished book written by Dr Wylie D. Gibbons, a 90 year old surgeon from Queensland Australia.  The title, as shown in the image below, is "Gastric Hypothermia for Major Haematemesis".
The book can be downloaded freely, even copied, at the clickable Dropbox web location here.
You can also view the several parts of the book by clicking here, which will make it faster to download.
If you cannot access Dropbox (e.g. from China) please use this link to my web server.

Background:

In the 1960's bleeding gastric and duodenal ulcers required emergency surgery.  Well, not exactly!  It was known that, in most cases, bleeding stopped before the patient bled to death.  So the strategy was to give "medical treatment" involving fasting, resting, washing out the stomach with a large bore tube, placing various solutions of drugs and antacids in the stomach, and waiting to see what happened.  All the while the patient was given blood transfusions.  After multiple transfusions, often completely replacing the patient's blood volume, surgery might be tried.  By this time the patient might be close to death and the anaesthesia itself could be fatal.

About then, a surgeon called Wangensteen at the University of Minnesota USA, on the basis of some animal experiments, introduced a machine to automatically lavage the stomach with ice water.  This process caught on and seemed to stop the bleeding in many cases.  At least it was better than nothing.

In this era, Wylie D. Gibbons learned the technique, critically evaluated then improved on it, and collected a series of patients in Rockhampton Queensland.  These formed the basis of his first thesis submitted in 1965 to the University of Queensland.  The thesis was rejected.  Read on if you are interested.

My comment on the back cover is as follows:
"In the absence of the true cause of peptic ulcer, patients faced a future of terrible suffering or death and clinicians were desperate to save them. In Rockhampton Queensland, the person who took on this heroic duty was the local surgeon, Dr Wylie Gibbons." 

Links to the Book:

The book is identified by ISBN-13:978-1974454174 and ISBN-10: 1974454177

Wylie D. Gibbons Publishing, 
Villa 240, 
60 Endeavour Boulevard, 
North Lakes, Queensland 4509, 
AUSTRALIA.

Hard cover copies are available (printed as required) for USD$100 from the author. 
The book can be downloaded freely, even copied or reproduced, at the clickable Dropbox web location here.
You can also view the several parts of the book by clicking here, which will make it faster to download.
If you cannot access Dropbox (e.g. from China) please use this link to my web server.


Sunday, July 19, 2015

Hand Pain from using the iPhone

For several years I have noticed hand pain when holding the iPhone.  I always just assumed that it was caused by phone radiation heating the hand nerves or inducing a small voltage difference across the crucial membranes therein.  Tonight I performed a quick search on the subject and found a few entries claiming that it was a type of repetitive strain injury (RSI) or carpal tunnel syndrome.  I also saw various comments and replies attributing this phenomenon to "texter's thumb".
Personally I don't believe these.  There is no doubt that phone radiation can heat things, like my thenar muscle.  If I had time I would design a double blind placebo controlled study to test my hypothesis.  I think this would be a good school science project.  There is no evidence base for an opinion either way and if there was evidence (in the secret Apple archives) they would be crazy to release it.  Meantime, I'll keep an eye on this subject - maybe with a Google Alerts search as shown in this link which searches for "hand pain from radiation of iPhone".
Am I concerned? Not a bit.  We know that phones can heat things in their immediate proximity.  If they caused tumours we would have a massive outbreak of brain tumours amongst people like myself who have used a cellphone for 20 years.  It isn't happening.
The lesson from this is that plenty of content on the internet is useless, or just plain wrong.  This might include my comments here!

Thursday, July 09, 2015

Blogging Recommenced after Shenzhen Stock Market Fizzles

I have decided to re-start my blogging and will try to do a post at least each month, as I learn something new which I think might have value.  My thoughts came about when I saw a presentation two weeks ago by Kanghong Pharmaceuticals in Chengdu.  They were just about to list on the Shenzhen stock exchange.  Then they listed and three days later a mini global meltdown and a few trillion Yuan devaluation occurred in China stock prices.  Except for Kanghong!  Yep, they have a real product but their listing story is not what you would expect on Wall St.  However, there is no actual factual news available on the web for the lazy business people news services to re-write and publish.  This means in a vacuum of information, anything is news.  Therefore, from Shenzhen, any information can go viral and result in speculation.  As I see it, by throttling the information, the Chinese government ensures that market volatility prevails!  A brief article about the leader at Kanghong is here: "New Billionaire Clan Defies China's Wealth Plunge."
Chinese links can find more about Kanghong Chengdu Pharmacuetical company by searching on this name: ๆˆ้ƒฝๅบทๅผ˜่ฏไธš้›†ๅ›ข

Thursday, April 05, 2012

The 30th Anniversary of the Culture of Helicobacter pylori

On Easter Thursday 1982, which was the 8th of April, we performed endoscopy on a man in his 60's who I recall had a recurrent bleeding duodenal ulcer.  This was a major problem for him because he also had a heart valve problem and therefore was required to take anticoagulants (making him more likely to bleed from the ulcer).  Dr Warren and I were in the third week of a study of 100 consecutive endoscopy patients and we had already entered more than 30 patients in the study.  I took two gastric biopsies to the pathology lab and one to the micro lab (for Dr Pearman).
I have no idea what I did that Easter but I suspect that I was on-call as registrar in haematology with many very sick patients to attend to.  Luckily I lived only 15 minutes from Royal Perth Hospital.
In Perth, the Easter Break is four days (Good Friday to Easter Monday incl.) so the bacterial cultures which had been set up on the Thursday morning were not examined until Tuesday morning, at which time the typical "water spray" appearance of Helicobacter colonies were visible.
The next day, an excited John Pearman called me to come and see the bacteria they had grown from a patient cultured the previous Thursday.  He showed me the culture plates and we peered at the Gram stained smear of the bacteria through the lab microscope.  The bacteria were Gram-negative - pink (at least that part was correct) but were not obviously spiral - they were all shapes and sizes!  After 6 months of disappointment, I was not going to break out the champagne on such borderline evidence of success.  After all, why should we suddenly be able to grow the bacteria when all other attempts had failed?  What were we doing differently?  In the next week John's lab was able to culture Helicobacter (which we called Campylobacter in those days) from several more patients.  Reflecting on this, we realised that in the previous attempts, lab staff had been examining the plates after 48 hours then discarding them if nothing new was visible.  After all, biopsies covered in saliva and dragged up from the stomach through the channel of an endoscope would be severely contaminated with commensal organisms.  These irrelevant "commensal organisms" (fungus, oral streptococcus, bacillus and hundreds of other species) would be expected to completely cover the plates after 48 hours and obscure any new kind of bacteria.
But biopsy specimens taken from the human stomach for Helicobacter were a little different.  The wall of the stomach is exposed to a puddle of acid which kills most of the bacteria being swallowed from the mouth.  So the biopsy samples were sometimes almost sterile (except for Helicobacter pylori which lives under the protective mucus gel layer); and even non-selective blood agar plates could be incubated for 3-5 days with quite a few areas of clean agar visible upon which Helicobacter could slowly grow.
Normally, after two days, the lab technician would have discarded the cultures after seeing nothing worth keeping at the 48 hour inspection (Easter Saturday).  However, that Easter may have been particularly busy so that urgent cases took precedence over our clinical research; which was regarded more as a hobby than as science.  I recall that there was a MRSA (methicillin resistant staph-aureus) control program in the hospital that month so maybe the microbiology staff were overloaded.  In any case, on Easter Saturday, the technologist did not examine the research cultures and left them to sit for three more days until the Tuesday morning examination.  The first culture plate probably looked like this:

That first culture became the "type strain" of Helicobacter pylori, ATCC #11637.  This bacterial strain has been studied by thousands of research labs and costs £150 to obtain from the NCTC.  You can read about the type strain of Helicobacter pylori here: pdf file of NCTC citation copied on 2012-04-04

Tuesday, June 21, 2011

Are Aircraft Cancellations Really Necessary for Ash Clouds from Volcanoes Thousands of Miles Away?

There are four well described cases of flameouts caused by volcanic ash clouds which have been extensively studied and recorded. The article linked here by Marianne Guffanti discusses all these episodes and reviews the issue of volcanic ash in detail. One concludes from the article that there is actually very little data available on the subject.
The most famous near-crashes are:
1982, BA 9, Boeing 747, London to KUALA-LUMPUR to PERTH, Mount Galunggung volcano, Indonesia. Distance from Volcano = 100-200 km.
1982, SQ, Boeing 747, probable international flight, Mount Galunggung volcano, Indonesia. Distance from Volcano = Uncertain - but nearby.
1989, KLM, Boeing 747, Near Redoubt volcano Alaska, about 135 km from Anchorage.
2000, Unknown airline, Boeing 737-800, Mijake-jima volcano, Distance from Volcano = about 130 km (near Narita airport).
In all cases the plane was practically in sight of the volcano and flew into a dense cloud.
Mt Redoubt is 135 km from Anchorage so that ash cloud was very fresh. Actually, the KLM pilot described it as a "black" cloud.
The British Airways flight 9 to Perth was 100 km from the active volcano Mt Galunggung volcano and experienced a total flameout. The other episode occurred a few weeks later in the same area and that plane landed on two remaining engines somewhere in Indonesia.
There is only one likely report of engine damage after a faint ash cloud was penetrated by a jet. In the detailed report linked here, Thomas J. Grindle describes the case of a research DC-8 NASA jetplane which flew into a cloud of ash coming from Mt Hecla in Iceland. The cloud was not noticed by the crew but instruments recorded the event and they did not the absence of stars for 7 minutes. Aerosol of 20,000 particles per cm^3 were detected for seven minutes, as well as sulphur. The flight path was 800 miles north of the volcano and supposedly 200 km away from the cloud. The plane flew normally for another 47 hours then was inspected. There was internal abrasive engine damage probably caused by the ash cloud, although it is admitted that it had flown through a sandstorm a few days earlier after which no damage was discovered on internal inspection. This event is taken as evidence that even an invisible ash cloud can damage a plane. However, it is possible that the cloud was much denser than they thought since it was nighttime. Also, it was surprising that the windshield was not abraded, just the engine, which would support the sandstorm hypothesis since "sand blasting" was only seen in the engines. If the inspection after the sandstorm was deficient, would they have questioned it in the official report when at the time, it had little relevance?
Based on these data, should Australian travellers be grounded? The idea that an ash cloud could circumnavigate the globe and then, even though it appears to be a transparent brown stain on a satellite image, could noticeably affect a plane, has been accepted without question by Australian airlines. This is clearly a situation far beyond the actual recorded cases.
Presently, ash from Chilean volcano Puyehue must cross the Atlantic and Southern Oceans, a shortest distance of about 11,000 km and a "cloud path" distance of 19,000 km. The "ash cloud" is visible in thin streaks of light brown transparent air by satellite images. There is no apparent data as to how much ash is actually present. However, it logically would be extremely diluted. Its transparency must indicate a very small amount indeed.
An animated image of the ash cloud is shown below.

Like many things airlines do, cancelling Australian flights because of a Chilean volcanic eruption, has very little basis in fact. It might have about the same safety benefit as preventing people reading their Kindle during landing. The current cancellations of flights in Australia have affected more than 100,000 travellers but no-one has looked again at the evidence base for cancelling flights. Meantime it costs aviation, and the public, tens of millions of dollars (in Australia) and probably hundreds of millions in Europe and the USA (but there they are at least much closer to the volcano - typically planes are flying close to iceland and parallel to the ash cloud).
It would make sense to have research planes fly through the transparent ash cloud and take measurements so that we know how much ash is actually present when a cloud is visible. After that, the engine effects could be correlated with the air sample measurements. These could be posted on the web as ash concentration charts. Then we would know. There are other dissenting voices on the web, read the pilots forums.

June 21st 2011

Wednesday, January 12, 2011

My Latest Genome SNP report from DeCodeMe

This post is an update on my SNP genome scan report in which there has been a few developments. It came about because my dad (Bob Marshall) had his 80th birthday last week and we made a detailed report on his ancestry based on DeCodeMe. By the Y-chromosome he was related to Somerled the Viking-Scottish 12th century king (as are millions of other caucasians). However, I noted the high risk he has for macular degeneration (5x, 46%). This rang a bell because his grandmother (Jessie Boneham) went blind after "she had her cataracts removed but the operation didn't work" suggesting retinal disease after age 85 years. Anyway I looked again at my age related macular degeneration risk and see a lesser but elevated risk (2.88x, 23%). Last month my eye exam was normal except for early arcus senilis and slight refraction problems. I'll continue with a two yearly check. This year I decided to seriously attend to my blood pressure (erratic and about 20mm above ideal levels if not treated) and also my cholesterol. My SNP risks reflect a 50% risk of hypertension, as well as diabetes, obesity and heart attack (although modestly elevated). Good news is that my risk of muscle damage from my statin is low so I can take these with impunity. My recent blood pressure readings are graphed in one of the documents on the web site. An episode of angioedema caused me to change my ACE inhibitor to an ACE receptor blocker and so far I have not had any more side effects.

You can read my full SNP report plus other health reports here: http://www.bajama.mine.nu/~barry/decodeme/ . I also include an AVI file showing a movie of my coronary calcium CT scan and you can go into the directory below to see my actual raw SNP data in case you want to research it. I don't know what use this information is but I do want to hold true to my idea of a public health record. More and more people care less and less about this type of data - its becoming so common.

What else is new? Well, I am saving up to have my total genome done. I would also like to do my whole family, but the Western Australian DNA bank refuses to store the DNA at present. They are so precious that they only do storage for bona-fide research projects, not for people like me who are just exploring their own family. So I may just keep it frozen in the back of my -80C refrigerator at the H.pylori Research Lab.