Engineer & Entertain

Ideas I grapple with

Archive for the tag “health”

Cobalt F. Milanowski, M&M

He wrote hit Ke$ha songs

Situation

On 09 Dec 2013 at 1200 MST, Cobalt Foxunit Milanowski, my greyhound, died at a kennel. A staffer at the kennel passed the hound before letting some other dogs out and noticed he was laying around like greys typically do. A few minutes later he returned and noted blood was coming from Cobalt’s mouth. The kennel called several veterinarians and determined Cobalt died quickly and peacefully in a matter of minutes. The kennel called me immediately. I was mid-flight, returning home from a vacation and planning on picking up the dog that day.

The kennel offered to cover a necropsy. The logical side of me that wants to know what happened also told me to let go and let Cobalt have peace. The idea kept turning over in my head; ultimately, my clinical compulsion won and I ordered the autopsy.

Background

Cobalt had swelling on his right rear ankle on 12 Nov 2013. He saw a veterinarian on 16 Nov. The vet’s differential diagnosis included valley fever, a tick borne disease, and osteosarcoma.

A blood panel came back negative for valley fever. Rather than run a tick panel, doxycycline was given prophylactically to treat any tick borne illnesses. A radiograph displayed cortical bone loss which is a sign of canine osteosarcoma. The vet recommended we periodically x-ray the site to insure the loss did not become greater.

The swelling reduced some, but resumed a day before the vacation. My plan was to make a vet appointment for him upon my return, but death intervened.

Cobalt’s past medical history includes a heart murmur when dehydrated, a bout of vomiting (which was never diagnosed, but resolved itself), and cryptorchid which was resolved surgically before we adopted him.

Assessment

Another vet performed the necropsy. Upon gross examination the vet observed petechiae on the abdomen and free blood in the abdomen and thoracic cavity. He found a tumor on the left atrium (hemangiosarcoma). The disease typically begins around 8-10 years of age. Cobalt was 7; he was detrimentally precocious.

The vet reported Cobalt likely had an underlying malignancy which triggered an autoimmune storm.  A cascade of events occurred in a matter of hours and Cobalt’s death occurred in a matter of minutes.  His end was sudden, quick, and peaceful.

Recommendation

A hemangiosarcoma would not show up on radiographs and would only be visible on an ultrasound. If the disease was detected in its very early stages, then treatment might have been a possibility. Chemotherapy would be performed in addition to a very vexing and delicate surgery to remove the tumor from Cobalt’s atrium. Even with surgery and chemotherapy the hound’s life is only extended by 8-9 months. Furthermore its treatment is generally limited to the expertise of a veterinary cardiologist, something not found in Flagstaff. Cobalt’s life might have been extended, but at what cost to the dog’s quality of life?

Given there were no outward signs nothing could have been done. Even if the disease was detected, at this stage the animal’s death could occur at any time. Early detection is the key to cancerous conditions in both humans and animals.

I am grateful for Cobalt. I am also grateful he did one last thing for me and expanded my knowledge of canine health. I miss my hound. Hopefully his dog brain was able to understand that my wife and I love him dearly.

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Ignaz to know you

I am participating in No Shave November, but since it is also flu season I am also participating in Wash Your Hands To Reduce Communicable Diseases. This is actually something I participate in frequently through out the day, but now seems as good as any time to celebrate it – unless you count Global Hand Washing Day on Oct 15th.

I digress. I cannot stress the importance of hand washing enough; however, Ignaz Semmelweis can.

In the mid-19th century, 25% of women who caught puerperal fever while delivering their baby would die.  Dr. Semmelweis was an obstetrician in Vienna and worked between two clinics run by the Vienna General Hospital.  The first clinic had an average mortality rate of 10% from puerperal fever.  The second clinic had a rate of 4%.  The clinics admitted delivering women on alternate days.  Some women opted to give birth at home or in the streets rather than go to the first clinic.  These women had lower rates of puerperal fever.  How could the streets of Vienna be a better place to give birth than a hospital?

Ignaz compared the two wards and took into account the population, techniques, even religious practices.  The only difference were their students.  The second clinic trained midwives only.  The first clinic trained medical students and they were required to perform autopsies and learn from cadavers.  The med students and their instructors would go from handling dead, decaying bodies to delivering infants. To our modern eyes this is clearly a horrible idea, but the germ theory of disease would not be proven for another 30 years.

Semmelweis was not the only person to hypothesize doctors could transmit disease to their patients.  There were many reasons why physicians did not immediately wash their hands.  Semmelweis and the other physicians only had anecdotal evidence and they lacked a clear explanation of what was being transmitted.  The thought that disease and cleanliness are linked went against medical training at the time.  Also not helping matters, was that Semmelweis bullied other doctors and hospital staff into washing their hands.  Furthermore, washing your hands did not involve soap and water at the time, it involved a bleaching agent would could irritate the skin.

Ignaz was obsessive about puerperal fever and hand washing. It consumed his life.  Eventually he was committed to an asylum where, in tragic irony, he would die of an infection.  Works by Dr. John Snow, Joseph Lister, and Louis Pasteur would vindicate Semmelweis’s observations and recommendations.

Physicians should have listened to him. Ignaz was money.

Organic food critic

A recent review of organic food studies found organic food is not more nutritious than conventionally grown food.  The review is performed by Crystal Smith-Spangler, M.D. at Stanford. It was funded by the school and not by any particular food or agricultural council.  Dr. Smith-Spangler performed the study because she is a practicing physician and received questions about organic foods.  It should be noted the review focuses on the nutritional benefit of organic farming and not the agricultural or ecological benefits.

Let me explain this review. No there’s too much, let me sum up.

  • Nutrient wise there is no difference between the organic and conventional foods.
  • Food contamination is no different either i.e. organic beef is just as likely to have E. coli as conventional beef.
  • On a short term assessment, eating organic foods does not affect asthma, eczema, or allergies.
  • There are lower levels of pesticides found in humans who consume organic foods. That said, neither level of pesticide neared the maximum limit.
  • Organic livestock is less likely to have bacteria resistant to 3 or more antibiotics.

Dr. Smith-Spangler’s analysis likely raises more hypotheses than it answers.  Another study should be performed to show long term effects of pesticides in humans.  It is possible the pesticides, organic or conventional, may reside in our body and cause horrible diseases.  It is also possible our amazing bodies excrete the pesticides as quickly as they come in without any detrimental effects.  This is why we have science.  For additional explanation and rational discourse consult Dr. Novella’s post on Science Based Medicine.

Spinning in your grave

I really wish I would have thought of this – the easy inter burial container is a coffin which is buried vertically instead of horizontally and is placed in the ground not by digging a huge hole, but by screwing it into the ground.

Screwed in life, screwed in death

Have Mercy!

But not for meningitis.   Lori Loughlin aka Aunt Becky from Full House encourages getting vaccinated against bacterial meningitis.  I second this idea.

You can prevent bodily harm or death from meningitis by getting a vaccine.  What is not to like?  Aside from the meningitis.

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