Seems I'm always asking for Purrs...

Howard Berkowitz wrote:
snip

One of the things that has helped me is that in developing expert
systems that interact with physicians, the system dialogue and report

must sound as if a physician wrote it. This required me to study, in
detail, how clinicians talk to one another.

Sorry for butting in here, but this really struck a chord with me. I
think what you are referencing (the type of dialogue wherein there is a
leap of thought) is common among any group of highly specialized
professionals. I know my husband (computer hardware design engineer)
and his colleagues do something similar, and I know when I was in
research (molecular biology), I did as well - particularly with those
with whom I had especially good rapport.

Anyway, carry on...I'm enjoying the thread drift...

-L.

In article , "Treeline"
wrote:

"Howard Berkowitz" wrote in message
...

One of the things that has helped me is that in developing expert
systems that interact with physicians, the system dialogue and report
must sound as if a physician wrote it. This required me to study, in
detail, how clinicians talk to one another.

Jargon is critical when dealing with an "in" group. I have noticed that
nuclear
physicists do not have to rely on jargon but then, they are relying on
reality.
In other words, I can attend a lecture on advanced nuclear physics and
follow
most of it, even the equations to a degree, without any advanced
knowledge -
aside from knowing a little math and how the universe is set up with
particles
and what not. I cannot do that in medicine, not because the concepts are
difficult. Most of them are at the idiot savante or baby level. Because
the
jargon is not defined for the lay people, on purpose and laziness, I
always
have to ask, when you said Vancomycin was reserved for Grand Rounds, did
that
mean...

That's an excellent example of very high medical context. To some extent
even now, and certainly for quite some time, vancomycin was the "last
ditch" antibiotic that could deal with some bacteria resistant to
everything. Many hospitals insist that an infectious disease consultant
approve its use, even though a fully licensed physician prescribed -- on
the theory the ID consultant may be able to figure out SOME alternative.

Many laymen hear about this, think vancomycin is the "strongest"
antibiotic, and want it -- yet it may not even affect their particular
disease. While people speak of strong and weak antibiotics, that really
isn't a useful term -- either an antibiotic hits a particular disease,
or it doesn't. Again, there are exceptions to everything -- many of the
vancomycin resistant strains will yield to combinations of drugs to
which individually had no effect. There are also some standard
combinations of antibiotics (using the term a little loosely) that are
very rational but subtle mixtures. To take one example that cats seem to
get frequently, Clavamox is a mixture of the antibiotic amoxicillin, and
clavulanic acid, which "lures away" an enzyme, penicillinase, that would
normally inactivate amoxicillin.

I've heard very proper clinicians and researchers emit extremely foul
curses when there's a report of even vancomycin-tolerant organisms.
Unfortunately, there are some cases where it's warranted to prescribe it
as a first drug, and these are accepted exceptions -- say, bacterial
menigitis in a penicillin-allergic patient.

We now have a few new classes of antibiotics, such as streptogramins,
that hit vancomycin-resistant organisms. Again, the responsible people
are trying NOT to prescribe them if there is no other possible choice --
although their manufacturers would like return on investment.

Don't get me started on the subject of using antibiotics as agricultural
animal growth stimulants. It's a major source of resistant infections in
himans.

It's emphatically not a matter of vocabulary, but learning the
tremendous amount of contextual assumptions under which the
connversation happens. For example, physician X may ask the result of a
particular blood test. Physician Y understands that X is less concerned
with the actual test than of a certain implied diagnosis. Y responds
with the result of a urine test that rules out the diagnosis.

This makes perfect sense to the physician, but will sound like
gibberish
to anyone who doesn't know the context. I have found that when I make
one or two contextual leaps like that in context, the other person may
reflexively start calling me "doctor".

That happens to me. But when I say I am not a doctor then they get all
discombobulated that I may know more than they do. I may not actually
know
"more" but my bias is less, hence my sphere of knowledge increases, to
twist
Blaise Pascal, just a bit. [As the diameter, or radius if you prefer, of
my
knowledge grows, so does the ignornace displayed by the circumference of
the
circle.]

There are other speech patterns that have this sort of effect --
discussing "the differential" and possibly identifying things that you
would rule out, etc. Unfortunately, there's no simple way to get this
across. You have to be reasonably familiar with some of the textbooks
and current journals they look at.

That's hard to do when my hands are shaking but you're right.

It's often how you say it, as much or even more than what you say. It
can get funny with some nurses. Some nurses are absolutely delighted
with knowledgeable patients, but some are really threatened. In the
abstract, it can get funny when a hospital nurse tells you do do
something, and you say "no". I respond to the usual "but it's hospital
policy" with "it's not my policy." Other useful responses include "What
part of NO do you fail to understand?" or "I am not a patient. I am an
impatient."

Sometimes, the confrontations can get interesting. I had a really bad
nursing unit after I got my pacemaker. I seriously tried to leave during
the night, but my cardiologist, an old friend, talked me into staying
until morning.

In the morning, I got an extremely confrontational head nurse who came
in saying "I hear you gave MY nurses a hard time." I responded that it
bothered me that after my telemetry would have indicated I was dead, no
one responded. I asked if the discharge order had been written, and she
bluffed and said I had to wait for the pacemaker educator.

Conveniently, my room had a whiteboard, and I sketched in the major
logic and connections of a pacemaker "You mean so I can learn something
like this?" She growled.

As Monty Python fans will recognize, I explained to her that the number
of concern was three. She had three choices, not two and not four. One
was to remove my IV and let me leave. Two was to give me the dressings,
I would properly take out the IV, and leave. Three was that I'd take out
the IV, control bleeding with the sheets, and leave.

She said I was bluffing. I took choice #3.

What is your ejection fraction before I forget? Around 55%?

Around that, conservatively -- some studies give 60%. When I had my
first episode of angina, it was 65%. After reocclusion after bypass, it
was down to about 35%, but has steadily been coming back up under
aggressive medical management.

An amazing success story.


Very interesting genetically. Both the early predisposition to heart
disease, which killed my father at 42, and the ability to grow new blood
vessels, are both genetically determined. Sir William Osler, one of the
greatest names in medicine, once said "the best way to have a long life
is to get a chronic disease and treat it well." I first was diagnosed
with high blood pressure in my early thirties, and began immediate and
aggressive treatments--things that weren't available when my father
first deeloped problems -- which very well might not have been picked up
on screening that wasn't done at the time.

Sadly, when we think of our feline friends, he wrote "God, when you take
me, don't let it be through the kidney."

In article . com, "L.
(usenetlyn)" wrote:

Howard Berkowitz wrote:
snip

One of the things that has helped me is that in developing expert
systems that interact with physicians, the system dialogue and report

must sound as if a physician wrote it. This required me to study, in
detail, how clinicians talk to one another.

Sorry for butting in here, but this really struck a chord with me. I
think what you are referencing (the type of dialogue wherein there is a
leap of thought) is common among any group of highly specialized
professionals. I know my husband (computer hardware design engineer)
and his colleagues do something similar, and I know when I was in
research (molecular biology), I did as well - particularly with those
with whom I had especially good rapport.

Laughing...do you ever mix the two? One of the things that I do is
design hospital networks and patient monitoring, which puts me in the
"computer" category to some of the medical staff. It bothers them,
somehow, when I don't talk "computer", but hit them with physiology and
molecular pharmacology.


Anyway, carry on...I'm enjoying the thread drift...

-L.


I wonder if sewing groups suffer from thread drift?

I suspect many of us would also agree it's not what hoomins meow, but
how they do it.

"Howard Berkowitz" wrote in message
...

In article , "Treeline"
wrote:
Jargon is critical when dealing with an "in" group. I have noticed that
nuclear physicists do not have to rely on jargon but then, they are
relying on
reality. In other words, I can attend a lecture on advanced nuclear physics
and
follow most of it, even the equations to a degree, without any advanced
knowledge - aside from knowing a little math and how the universe is set up
with
particles and what not. I cannot do that in medicine, not because the
concepts are
difficult. Most of them are at the idiot savante or baby level. Because
the jargon is not defined for the lay people, on purpose and laziness, I
always have to ask, when you said Vancomycin was reserved for Grand Rounds,
did
that mean...

That's an excellent example of very high medical context. To some extent
even now, and certainly for quite some time, vancomycin was the "last
ditch" antibiotic that could deal with some bacteria resistant to
everything. Many hospitals insist that an infectious disease consultant
approve its use, even though a fully licensed physician prescribed -- on
the theory the ID consultant may be able to figure out SOME alternative.

Many laymen hear about this, think vancomycin is the "strongest"
antibiotic, and want it -- yet it may not even affect their particular
disease. While people speak of strong and weak antibiotics, that really
isn't a useful term -- either an antibiotic hits a particular disease,
or it doesn't. Again, there are exceptions to everything -- many of the
vancomycin resistant strains will yield to combinations of drugs to
which individually had no effect. There are also some standard
combinations of antibiotics (using the term a little loosely) that are
very rational but subtle mixtures. To take one example that cats seem to
get frequently, Clavamox is a mixture of the antibiotic amoxicillin, and
clavulanic acid, which "lures away" an enzyme, penicillinase, that would
normally inactivate amoxicillin.

Interesting, sort of what is used with heliobacter pylori, the new, really
old-time discovery that stomach ulcers are really this silly infection that
when it causes cancer is not so funny. In any case, they use bismuth, per se,
to keep the stomach from inactivating the antibiotic which is also amoxicillin
I think. Good for cats. Good for people. How many people died from bleeding
ulcers when it was really h. pylori and a simple test, treatment and 100% cure.
Sad. This took 20 years. Why are we all so damn stupid?

My cat decided to increase her menu [apparently she was incensed being told she
had to lose weight, like a very proud and indignant female...] so caught a fat
field mouse and ate it in right there in front of me. And got the runs for four
days. I had some Clindamycin laying around. So I got to thinking... probably
she is not used to the bacteria in that mouse or that mouse had something extra
bad. Well, she is 10 pounds, and a human is 150 pounds, so if I give her not
1/15th but around 1/30th the dosage, probably won't do much harm and
Clindamycin appears in the vet literature as a good antibiotic. It's dangerous
with people on rare occasions if taken long term but a couple of days should be
okay for cats or non-cats. Cleared her right up immediately. Coincidence? Doubt
it. Just opened a capsule and sprinkled it on some tuna - couldn't have been
simpler. Erred on the side of caution but looked it up in the vet lit before I
did anything. I have to take her again to the vet for a general checkup but I
need to decide on a birthdate and name. I keep changing her name so it's
confusing for the vet records you know... And she needs to lose 2 pounds
because I am putting her on a caloric restricted adequate nutrition diet, as
popularized by Roy Walford. That's another thread, doubling the life expectancy
of mammals. So it's in her benefit not to see the vet because then her food is
going to be weighed at the gram level, poor baby. Grouchy she'll be.

I've heard very proper clinicians and researchers emit extremely foul
curses when there's a report of even vancomycin-tolerant organisms.
Unfortunately, there are some cases where it's warranted to prescribe it
as a first drug, and these are accepted exceptions -- say, bacterial
menigitis in a penicillin-allergic patient.

We now have a few new classes of antibiotics, such as streptogramins,
that hit vancomycin-resistant organisms. Again, the responsible people
are trying NOT to prescribe them if there is no other possible choice --
although their manufacturers would like return on investment.

Don't get me started on the subject of using antibiotics as agricultural
animal growth stimulants. It's a major source of resistant infections in
himans.

The Danes, great people, were the first to point this out, I believe. I love
the logic. Get cows 5% fatter and endanger the entire human population with
theoretically useless antibiotics or whatever. Got to love those evil cattle
ranchers. They were always the bad guys in the cowboy movies. Bush is a cattle
rancher?

It's emphatically not a matter of vocabulary, but learning the
tremendous amount of contextual assumptions under which the
connversation happens. For example, physician X may ask the result of a
particular blood test. Physician Y understands that X is less concerned
with the actual test than of a certain implied diagnosis. Y responds
with the result of a urine test that rules out the diagnosis.

This makes perfect sense to the physician, but will sound like
gibberish to anyone who doesn't know the context. I have found that when
I make
one or two contextual leaps like that in context, the other person may
reflexively start calling me "doctor".

That happens to me. But when I say I am not a doctor then they get all
discombobulated that I may know more than they do. I may not actually
know "more" but my bias is less, hence my sphere of knowledge increases, to
twist Blaise Pascal, just a bit. [As the diameter, or radius if you prefer,
of
my knowledge grows, so does the ignornace displayed by the circumference of
the circle.]

There are other speech patterns that have this sort of effect --
discussing "the differential" and possibly identifying things that you
would rule out, etc. Unfortunately, there's no simple way to get this
across. You have to be reasonably familiar with some of the textbooks
and current journals they look at.

That's hard to do when my hands are shaking but you're right.

It's often how you say it, as much or even more than what you say. It
can get funny with some nurses. Some nurses are absolutely delighted
with knowledgeable patients, but some are really threatened. In the
abstract, it can get funny when a hospital nurse tells you do do
something, and you say "no". I respond to the usual "but it's hospital
policy" with "it's not my policy." Other useful responses include "What
part of NO do you fail to understand?" or "I am not a patient. I am an
impatient."

Sometimes, the confrontations can get interesting. I had a really bad
nursing unit after I got my pacemaker. I seriously tried to leave during
the night, but my cardiologist, an old friend, talked me into staying
until morning.

In the morning, I got an extremely confrontational head nurse who came
in saying "I hear you gave MY nurses a hard time." I responded that it
bothered me that after my telemetry would have indicated I was dead, no
one responded. I asked if the discharge order had been written, and she
bluffed and said I had to wait for the pacemaker educator.

Conveniently, my room had a whiteboard, and I sketched in the major
logic and connections of a pacemaker "You mean so I can learn something
like this?" She growled.

As Monty Python fans will recognize, I explained to her that the number
of concern was three. She had three choices, not two and not four. One
was to remove my IV and let me leave. Two was to give me the dressings,
I would properly take out the IV, and leave. Three was that I'd take out
the IV, control bleeding with the sheets, and leave.

She said I was bluffing. I took choice #3.

I find it difficult to stand up to Nurse Rachet and Doctor Whore if I am in a
bad way. You did a great job. I feel very bad that I did not file against their
licenses. Even if it does no good, it's on the record. One is now head of the
Cleveland Clinic. I feel badly now that I did not file and swear out a formal
affadavit against him. I still may. Now to start a blog with names, dates,
details, it's all in the details. Just have to start. So start in a cat
newsgroup and go from there I guess.

Very interesting genetically. Both the early predisposition to heart
disease, which killed my father at 42, and the ability to grow new blood
vessels, are both genetically determined. Sir William Osler, one of the
greatest names in medicine, once said "the best way to have a long life
is to get a chronic disease and treat it well." I first was diagnosed
with high blood pressure in my early thirties, and began immediate and
aggressive treatments--things that weren't available when my father
first deeloped problems -- which very well might not have been picked up
on screening that wasn't done at the time.

Sadly, when we think of our feline friends, he wrote "God, when you take
me, don't let it be through the kidney."

I agree. Just let me pee. As I said to the Great One in the sky, paraphrasing
you know who.

In article , "Treeline"
wrote:

"Howard Berkowitz" wrote in message
...


Interesting, sort of what is used with heliobacter pylori, the new,
really
old-time discovery that stomach ulcers are really this silly infection
that
when it causes cancer is not so funny. In any case, they use bismuth, per
se,
to keep the stomach from inactivating the antibiotic which is also
amoxicillin
I think.

I'd have to check the literature, but, IIRC, bismuth actually has direct
activity against H. pylori. There are several treatment regimens,
generally involving multiple antibiotics, often bismuth, and at least an
acid pump inhibitor and maybe a H2 receptor blocker. The latter two keep
the stomach lining calmer while treatment is going on, minimizing
furhter acid burns.

Different regimens probably have comparable effectiveness, but it's nice
to have alternative proven mixtures if a patient is allergic to a
component. Also, a portion of patients, 10-20% from memory, don't get
the H.pylori knocked out in the first treatment, but a second round with
an alternate regimen is almost certain to cure it.

Good for cats. Good for people. How many people died from
bleeding
ulcers when it was really h. pylori and a simple test, treatment and 100%
cure.
Sad. This took 20 years. Why are we all so damn stupid?

One of the problems was less the treatment than the testing. Today, we
use the simple, noninvasive, and extremely accurate urease breath test.
Originally, however, the assumption was that it could only be diagnosed
with a biopsy from the stomach wall, usually through an endoscope but
still an invasive and expensive procedure requiring a subspecialist.


My cat decided to increase her menu [apparently she was incensed being
told she
had to lose weight, like a very proud and indignant female...] so caught
a fat
field mouse and ate it in right there in front of me. And got the runs
for four
days. I had some Clindamycin laying around. So I got to thinking...
probably
she is not used to the bacteria in that mouse or that mouse had something
extra
bad. Well, she is 10 pounds, and a human is 150 pounds, so if I give her
not
1/15th but around 1/30th the dosage, probably won't do much harm and
Clindamycin appears in the vet literature as a good antibiotic. It's
dangerous
with people on rare occasions if taken long term but a couple of days
should be
okay for cats or non-cats.

With humans, there is considerable concern about using clindamycin if
there are alternatives. The danger is causing an overgrowth of
Clostridium difficile in the gut, leading to pseudomembranous
enterocolitis, which can cause fatal diarrhea. The only treatment for
that used to be oral vancomycin (it isn't absorbed systemically), but
we've now happily found that the much safer, cheaper, and less
resistance-critical metronidazole works just as well.

I wouldn't be surprised if the normal intestinal bacteria in an obligate
carnivore like a cat is different from humans, but I'd still be careful
with using any antibiotic, clindamycin especially. Yes, there definitely
are rational situations to give an antibiotic without a firm diagnosis
by culture, but I wouldn't consider unexplained diarrhea one of them.
Any animal with diarrhea or vomiting is trying to get rid of a toxic
substance. In most acute cases, it's more important to avoid
dehydration and just let the system cleanse itself. Probably the classic
example is cholera -- while Vibrio cholerae, the cause, is sensitive to
antibiotics, they usually are not given. Instead, oral rehydration, or
IV in desperately ill patients, is used until the body returns to normal.



The Danes, great people, were the first to point this out, I believe. I
love
the logic. Get cows 5% fatter and endanger the entire human population
with
theoretically useless antibiotics or whatever.

Well, no. They aren't useless, or you wouldn't see the weight increase.
Nevertheless, I am utterly opposed to their use, for human public health
reasons.


That happens to me. But when I say I am not a doctor then they get
all
discombobulated that I may know more than they do. I may not actually
know "more" but my bias is less, hence my sphere of knowledge
increases, to
twist Blaise Pascal, just a bit. [As the diameter, or radius if you
prefer,
of
my knowledge grows, so does the ignornace displayed by the
circumference of
the circle.]

I'll have to admit that counter-arrogance sometimes works, as in "you
HAVE ruled out Gabblefritzie's Syndrome, haven't you?" The hypothetical
syndrome I use exists, but the message is that a layman wouldn't know
about it even to suspect it. That's changed somewhat with the ability
of people to research odd conditions on the Internet, but it's very hard
for a clinician to claim someone just memorized a few things when they
can cross-examine without notes.

Most of the time, though, I find it's pretty friendly. I've had several
discussions recently on changing maintenance drugs, and, with a good
physician (and even students listening), we mapped out a strategy of
starting with the most likely to succeed change, and then trying others
in order. We also added some nuances like checking the blood level of
some drugs that might be working better, to see if the dosage is
adequate.


As Monty Python fans will recognize, I explained to her that the number
of concern was three. She had three choices, not two and not four. One
was to remove my IV and let me leave. Two was to give me the dressings,
I would properly take out the IV, and leave. Three was that I'd take
out
the IV, control bleeding with the sheets, and leave.

She said I was bluffing. I took choice #3.

I find it difficult to stand up to Nurse Rachet and Doctor Whore if I am
in a
bad way. You did a great job.

As long as I can communicate, I do pretty well. One amusing thing is
that when I have a high fever or are otherwise very sick, I lose the
ability to talk coherently but can still communicate well in writing.
I've mentioned this to three friends, a physician and two biochemically
oriented psychologists, and they all want me to get a PET scan of
Broca's area. Given the insurance situation, I just have to find a study
that's interested in doing that. I feel vaguely cheated, since, offhand,
PET scanning is the only modern imaging technique I haven't had (not
counting variants like spiral CT).


Sadly, when we think of our feline friends, he wrote "God, when you
take
me, don't let it be through the kidney."

I agree. Just let me pee. As I said to the Great One in the sky,
paraphrasing
you know who.


I was once in a bull session with a group of residents, and asked them
why they went into their particular specialty. The one that seemed
happiest in his choice was the urologist. He explained that in no other
specialty did he find as many grateful patients -- either because they
could pee again or regained sexual function.

"Howard Berkowitz" wrote in message
...

One of the problems was less the treatment than the testing. Today, we
use the simple, noninvasive, and extremely accurate urease breath test.
Originally, however, the assumption was that it could only be diagnosed
with a biopsy from the stomach wall, usually through an endoscope but
still an invasive and expensive procedure requiring a subspecialist.

That's a lot of good knowledge. And it's helpful to have a diagnosis. But if
heliobacter pylori, or h. pylori is ubiquitous, and if found with stomach
problems, can cause stomach cancer, why not take a regimen of antibiotics
without the invasive procedure and see? I remember discussing this with a med
student before it became common knowledge, about 10 years ago. And that's
exactly what he did. And cured himself.


With humans, there is considerable concern about using clindamycin if
there are alternatives. The danger is causing an overgrowth of
Clostridium difficile in the gut, leading to pseudomembranous
enterocolitis, which can cause fatal diarrhea. The only treatment for
that used to be oral vancomycin (it isn't absorbed systemically), but
we've now happily found that the much safer, cheaper, and less
resistance-critical metronidazole works just as well.

Again, very helpful knowledge. Just yesterday I was discussing with Kat her use
of Clindamycin for 10 days for a wisdom tooth infection. I asked if her dentist
knew she had collitis? I pointed out that this side effect of Clindamycin would
seem to indicate using a different antibiotic since she has had many years of
problems with collitis and other stomach abnormalities. Her dentist knew. Well,
now she knows there is a danger and there are alternatives, like erythromycin,
and variations of erythromycin which in its plain form causes the tummy to get
upset.


I wouldn't be surprised if the normal intestinal bacteria in an obligate
carnivore like a cat is different from humans, but I'd still be careful
with using any antibiotic, clindamycin especially. Yes, there definitely
are rational situations to give an antibiotic without a firm diagnosis
by culture, but I wouldn't consider unexplained diarrhea one of them.
Any animal with diarrhea or vomiting is trying to get rid of a toxic
substance. In most acute cases, it's more important to avoid
dehydration and just let the system cleanse itself. Probably the classic
example is cholera -- while Vibrio cholerae, the cause, is sensitive to
antibiotics, they usually are not given. Instead, oral rehydration, or
IV in desperately ill patients, is used until the body returns to normal.

I did wait 4 days to see if Cat would improve. Cat did not improve. Hmmm. So I
am not sure when dehydration would start to set in. Cat does not drink a lot of
water and that's not good.

The last time Cat got the runs, I thought it was due to giving her new types of
wet food. I forgot she may have eaten a rodent at the same time. But the runs
went away when I immediately stopped the new brand of wet food, which I bought
in a health foods store. The cheaper Whole Foods store brand I think instead of
the expensive Pet Guard Chicken Lite Dinner. She turned up her pink nose at the
Rabbit. Rabbits are pets and not to be eaten, says she.


Well, no. They aren't useless, or you wouldn't see the weight increase.
Nevertheless, I am utterly opposed to their use, for human public health
reasons.

You're right. They are not useless for 5% weight gain for the owners of the
cows to make a profit. But for the majority of humanity who face a risk from
antibiotic resistance and may not be interested in eating those mad cows...
worse than useless... DANGEROUS



I'll have to admit that counter-arrogance sometimes works, as in "you
HAVE ruled out Gabblefritzie's Syndrome, haven't you?" The hypothetical
syndrome I use exists, but the message is that a layman wouldn't know
about it even to suspect it. That's changed somewhat with the ability
of people to research odd conditions on the Internet, but it's very hard
for a clinician to claim someone just memorized a few things when they
can cross-examine without notes.

??? Who cross-examines without notes? Cross-examine is about it. The patient
denies...

Oh I see, they cross-examine without notes, memorizing a few things. Usually
they always get something wrong, in my experience.

I cannot google Gabblefritzie, I gather this is for illustrative purposes only
then? A syndrome for the cats' newsgroup.


As long as I can communicate, I do pretty well. One amusing thing is
that when I have a high fever or are otherwise very sick, I lose the
ability to talk coherently but can still communicate well in writing.
I've mentioned this to three friends, a physician and two biochemically
oriented psychologists, and they all want me to get a PET scan of
Broca's area. Given the insurance situation, I just have to find a study
that's interested in doing that. I feel vaguely cheated, since, offhand,
PET scanning is the only modern imaging technique I haven't had (not
counting variants like spiral CT).

Interesting. Are you sure a what, BEAM [Brain Electrical Activity Mapping] unit
might not find anything topically of interest? This is a fancy EEGs mapping
with the data contrasted with a known data base for areas out of the common
findings. Keep finding Carl Sagan's book instead of where this is located and
if EEGs might indicate something or if it's too deep inside the brain.

There are clones of the BEAM unit, fairly cheap, 1/10th the cost, so it's
possible for anybody, who instead of going for the top of the line SUV, opts
for a slightly smaller vehicle, and can also have a BEAM unit or equivalent to
see where the brain is going to go today.

I wouldn't be surprised if the normal intestinal bacteria in an obligate
carnivore like a cat is different from humans, but I'd still be careful
with using any antibiotic, clindamycin especially. Yes, there definitely
are rational situations to give an antibiotic without a firm diagnosis
by culture, but I wouldn't consider unexplained diarrhea one of them.

Getting culture, finding those able to culture culture. What would I say? Take
a stool sample to a vet and say culture this? Culture for what? Gram negative?
How expensive would cultures be?

I forget who has mostly the gram positive and the gram negative. I know the
cats have Multocida pasturella and we humans do not. But what would the rodents
have? Does Clindamycin also kill some parasites the rodents might have? When I
read up on it, a little, I thought, a few doses of an antibiotic may be a good
thing. And that's all, about 3 doses is all she got since the cure was so
immediate. Could all be a coincidence but we shall leave David Hume out of the
cat group for the time being although he is a sweetheart of a philosopher. Is
causality just a figment of my cat's imagination?

Labor intensive. Need some petri dishes and a good microscope, really. I do not
have a good microscope any more. I do not think I ever had a good microscope. I
need to find a good, used microscope for these times. I would guess a beatup
but good microscope would easily cost one round of cultures, yes? A nice one
with a computer hookup so can record and send pictures to someone who might
identify since I am not used to this? A little stain here and see the baddies.

What would you suggest I ask them to culture for though?
S. aureus? that's everywhere?
So many germs, not enough dollars.


Any animal with diarrhea or vomiting is trying to get rid of a toxic
substance. In most acute cases, it's more important to avoid
dehydration and just let the system cleanse itself. Probably the classic
example is cholera -- while Vibrio cholerae, the cause, is sensitive to
antibiotics, they usually are not given. Instead, oral rehydration, or
IV in desperately ill patients, is used until the body returns to normal.

I did not know that. Easily treatable. Absurdly so. Not even need antibiotics.
So why do the people die? I guess if you need fluids and the fluids are
contaminated by cholera, it's a viscious cycle? Probably hard to get clean
water in countries where cholera is springing up. But there is boiling of water
if one has fire.

Wash hands and drink clean water. Where did I read that, printed 150 years ago?
The more things change...

WHO says:
Treatment of cholera
Cholera is an easily treatable disease. The prompt administration of oral
rehydration salts to replace lost fluids nearly always results in cure. In
especially severe cases, intravenous administration of fluids may be required
to save the patient's life.
Left untreated, however, cholera can kill quickly following the onset of
symptoms. This can happen at a speed that has incited fear and paralyzed
commerce throughout history. Although such reactions are no longer justified,
cholera continues to be perceived by many as a deadly and highly contagious
threat that can spread through international trade in food.

Left "untreated?" Water, maybe salt water, is the cure? Must be the lack of
clean water, dirty food, and re-infection that is really the problem since most
people will, I don't know what most people do when they get cholera. I think I
have a cholera immunization from long ago. Probably new strains by now.

In article , "Treeline"
wrote:

I wouldn't be surprised if the normal intestinal bacteria in an
obligate
carnivore like a cat is different from humans, but I'd still be
careful
with using any antibiotic, clindamycin especially. Yes, there
definitely
are rational situations to give an antibiotic without a firm
diagnosis
by culture, but I wouldn't consider unexplained diarrhea one of them.

Getting culture, finding those able to culture culture. What would I say?
Take
a stool sample to a vet and say culture this? Culture for what? Gram
negative?
How expensive would cultures be?

I don't know current commercial costs.


Labor intensive. Need some petri dishes and a good microscope, really. I
do not
have a good microscope any more. I do not think I ever had a good
microscope. I
need to find a good, used microscope for these times. I would guess a
beatup
but good microscope would easily cost one round of cultures, yes? A nice
one
with a computer hookup so can record and send pictures to someone who
might
identify since I am not used to this? A little stain here and see the
baddies.

What would you suggest I ask them to culture for though?
S. aureus? that's everywhere?
So many germs, not enough dollars.

Unfortunately, a microscope alone isn't enough even for many traditional
bacterial identification. Classic methods would involve culturing on
various selective growth media, isolating pure cultures, and then
reinoculating the cultures into tubes containing various sugars. The
pattern of sugars fermented and not fermented is often the best way to
identify.

When the fermentation required enough growth to see a color change of a
pH indicator, you needed 24-48 hours, at least, to get the reaction.
Now, microchemical instruments detect very small amounts of fermentation
gas from radioactively labelled sugars, giving fast results. There are
also many very specific immune tests.


Any animal with diarrhea or vomiting is trying to get rid of a toxic
substance. In most acute cases, it's more important to avoid
dehydration and just let the system cleanse itself. Probably the
classic
example is cholera -- while Vibrio cholerae, the cause, is sensitive
to
antibiotics, they usually are not given. Instead, oral rehydration,
or
IV in desperately ill patients, is used until the body returns to
normal.

I did not know that. Easily treatable. Absurdly so. Not even need
antibiotics.
So why do the people die? I guess if you need fluids and the fluids are
contaminated by cholera, it's a viscious cycle? Probably hard to get
clean
water in countries where cholera is springing up. But there is boiling of
water
if one has fire.

THere's a slight but critical addition. UNICEF received the Nobel Peace
Prize in 1995 for several developments including oral rehydration
therapy, but I would have no problem if the developers har received the
Nobel Prize in Medicine and Physiology.

If you give a patient with a severe diarrhea, such as that of cholera, a
solution containing sodium and even potassium and other ions, they will
probably die. If you add sugar or a soluble starch to that solution,
the patient will absorb the critical salts and live. You could support
them with the plain salts intravenously, but that's not practical in a
third-world epidemic.

One of the most effective rehydration solutions uses water in which rice
has been boiled and at least salt added. If available, it helps to add
sodium bicarbonate, and a source of potassium. Orange juice or mashed
bananas can supply the potassium.

Wash hands and drink clean water. Where did I read that, printed 150
years ago?
The more things change...

WHO says:
Treatment of cholera
Cholera is an easily treatable disease. The prompt administration of oral
rehydration salts to replace lost fluids nearly always results in cure.
In
especially severe cases, intravenous administration of fluids may be
required
to save the patient's life.
Left untreated, however, cholera can kill quickly following the onset of
symptoms. This can happen at a speed that has incited fear and paralyzed
commerce throughout history. Although such reactions are no longer
justified,
cholera continues to be perceived by many as a deadly and highly
contagious
threat that can spread through international trade in food.

Left "untreated?" Water, maybe salt water, is the cure?


Salt water WITH CARBOHYDRATE.

Must be the lack
of
clean water, dirty food, and re-infection that is really the problem
since most
people will, I don't know what most people do when they get cholera. I
think I
have a cholera immunization from long ago. Probably new strains by now.

In article , "Treeline"
wrote:

"Howard Berkowitz" wrote in message
...

One of the problems was less the treatment than the testing. Today, we
use the simple, noninvasive, and extremely accurate urease breath test.
Originally, however, the assumption was that it could only be diagnosed
with a biopsy from the stomach wall, usually through an endoscope but
still an invasive and expensive procedure requiring a subspecialist.

That's a lot of good knowledge. And it's helpful to have a diagnosis. But
if
heliobacter pylori, or h. pylori is ubiquitous, and if found with stomach
problems, can cause stomach cancer, why not take a regimen of antibiotics
without the invasive procedure and see? I remember discussing this with a
med
student before it became common knowledge, about 10 years ago. And that's
exactly what he did. And cured himself.

Remember that the diagnosis and treatment of H. pylori were evolving in
parallel. Before there was better data, some people were reluctant to
take a multidrug regimen without a confirmed diagnosis. Remember that at
the time, the proton pump inhibitors (e.g., omeprazole (Nexium)) were
cautiously used on prescription only for no more than 10 days. The
safety of this family of drugs is so much better established that they
are now available over the counter.

Many physicians are very conservative taking or prescribing drug
regimens that don't have at least multicenter test data.


With humans, there is considerable concern about using clindamycin if
there are alternatives. The danger is causing an overgrowth of
Clostridium difficile in the gut, leading to pseudomembranous
enterocolitis, which can cause fatal diarrhea. The only treatment for
that used to be oral vancomycin (it isn't absorbed systemically), but
we've now happily found that the much safer, cheaper, and less
resistance-critical metronidazole works just as well.

Again, very helpful knowledge. Just yesterday I was discussing with Kat
her use
of Clindamycin for 10 days for a wisdom tooth infection. I asked if her
dentist
knew she had collitis? I pointed out that this side effect of Clindamycin
would
seem to indicate using a different antibiotic since she has had many
years of
problems with collitis and other stomach abnormalities. Her dentist knew.
Well,
now she knows there is a danger and there are alternatives, like
erythromycin,
and variations of erythromycin which in its plain form causes the tummy
to get
upset.

Not so much variations of erythromycin but new synthetic drugs in the
class of macrolide antibiotics. There were a couple of erythromycin
variants that were less irritating to the stomach but proved toxic for
other reasons; erythromycin estolate is the only one I can remember but
I think there were two.

The main new-generation macrolides are azithromycin (Zithromax) and
clarithromycin (Biaxin). In general, both are superior drugs, with less
side effects, broader bacterial coverage, and much shorter treatment
times -- there are single dose regimens of Zithromax for some diseases,
with 5-7 once-a-day being more common and some up to 10 days.
Erythromycin is 4 times a day for 10-14 days.

Erythromycin, however, is one of the most inexpensive antibiotics, where
the second-generation macrolides are much more expensive.


I wouldn't be surprised if the normal intestinal bacteria in an
obligate
carnivore like a cat is different from humans, but I'd still be careful
with using any antibiotic, clindamycin especially. Yes, there
definitely
are rational situations to give an antibiotic without a firm diagnosis
by culture, but I wouldn't consider unexplained diarrhea one of them.
Any animal with diarrhea or vomiting is trying to get rid of a toxic
substance. In most acute cases, it's more important to avoid
dehydration and just let the system cleanse itself. Probably the
classic
example is cholera -- while Vibrio cholerae, the cause, is sensitive to
antibiotics, they usually are not given. Instead, oral rehydration, or
IV in desperately ill patients, is used until the body returns to
normal.

I did wait 4 days to see if Cat would improve. Cat did not improve. Hmmm.
So I
am not sure when dehydration would start to set in. Cat does not drink a
lot of
water and that's not good.

The last time Cat got the runs, I thought it was due to giving her new
types of
wet food. I forgot she may have eaten a rodent at the same time. But the
runs
went away when I immediately stopped the new brand of wet food, which I
bought
in a health foods store. The cheaper Whole Foods store brand I think
instead of
the expensive Pet Guard Chicken Lite Dinner. She turned up her pink nose
at the
Rabbit. Rabbits are pets and not to be eaten, says she.


Well, no. They aren't useless, or you wouldn't see the weight increase.
Nevertheless, I am utterly opposed to their use, for human public
health
reasons.

You're right. They are not useless for 5% weight gain for the owners of
the
cows to make a profit. But for the majority of humanity who face a risk
from
antibiotic resistance and may not be interested in eating those mad
cows...
worse than useless... DANGEROUS



I'll have to admit that counter-arrogance sometimes works, as in "you
HAVE ruled out Gabblefritzie's Syndrome, haven't you?" The hypothetical
syndrome I use exists, but the message is that a layman wouldn't know
about it even to suspect it. That's changed somewhat with the ability
of people to research odd conditions on the Internet, but it's very
hard
for a clinician to claim someone just memorized a few things when they
can cross-examine without notes.

??? Who cross-examines without notes? Cross-examine is about it. The
patient
denies...

Ah. But if you preempt the chart-speak "The patient requests that the
physician or nurse note in the chart that the patient states XXX and
denies YYY for the following reasons."...

Oh I see, they cross-examine without notes, memorizing a few things.
Usually
they always get something wrong, in my experience.

I cannot google Gabblefritzie, I gather this is for illustrative purposes
only
then? A syndrome for the cats' newsgroup.

Totally hypothetical syndrome, although sounding reasonably plausible
when you have things like Hashimoto's thyroiditis and Munchausen by
Proxy.


As long as I can communicate, I do pretty well. One amusing thing is
that when I have a high fever or are otherwise very sick, I lose the
ability to talk coherently but can still communicate well in writing.
I've mentioned this to three friends, a physician and two biochemically
oriented psychologists, and they all want me to get a PET scan of
Broca's area. Given the insurance situation, I just have to find a
study
that's interested in doing that. I feel vaguely cheated, since,
offhand,
PET scanning is the only modern imaging technique I haven't had (not
counting variants like spiral CT).

Interesting. Are you sure a what, BEAM [Brain Electrical Activity
Mapping] unit
might not find anything topically of interest? This is a fancy EEGs
mapping
with the data contrasted with a known data base for areas out of the
common
findings. Keep finding Carl Sagan's book instead of where this is located
and
if EEGs might indicate something or if it's too deep inside the brain.

I don't know anyone using them, but I do know of some PET programs.


There are clones of the BEAM unit, fairly cheap, 1/10th the cost, so it's
possible for anybody, who instead of going for the top of the line SUV,
opts
for a slightly smaller vehicle, and can also have a BEAM unit or
equivalent to
see where the brain is going to go today.

Again, it's not just observing an effect, but determining if there's
anything clinically useful that can be done with the information.

Howard Berkowitz wrote:

Remember that the diagnosis and treatment of H. pylori were evolving
in parallel

-----------------snip snip snip snip----------------------------

Many physicians are very conservative taking or prescribing drug
regimens that don't have at least multicenter test data.


May we discuss this a bit further with a recent example that makes me
wonder about "diagnosis and treatment ... evolving in parallel" and
"very conservative." Okay?

Recently I was discussing pianos and wave theory with someone.
Musical wave theory has a lot in common with brain waves except
for the pity and the PITA that we cannot hear below 20 Hz.

Okay, I digress. He told me how he had almost died about 10 years ago.
As he was telling me his story, I immediately thought of H. pylori.

In any case, this was his 3rd trip to the ER.
He had the lowest recorded hemoglobin reading of anyone in
that hospital who survived. So that's an achievement.

The quacks, in this case, gastro-quacks, were going
to take out his stomach.

Now does that sound like a conservative treatment based on the medical
literature?

As he put it, "the knives were circling the table..."

What saved his life and cured him was his wife. She, a nurse,
had heard the words H. pylori and said, perhaps some antibiotics
might be a little more whatever than taking out her husband's stomach.

Can you believe this greed and incompetence?

After a few days on antibiotics, he was cured permanently.
He probably stayed on the antibiotics for 2 weeks
but the improvement was immediate.

The audacity and the arrogance to take out someone's stomach
when H. pylori has been in the literature for 10 years at that point.

I just cannot comprehend the incompetence and prostitution in the
medical establishment.

Remember that Harvard study on unnecessary gallbladder operations?
It would be funny, to make boat payments as Click and Clack say,
except that elderly people especially run the risk of becoming
vegetables because of general anesthesia and the mistakes therein.



Not so much variations of erythromycin but new synthetic drugs in the
class of macrolide antibiotics. There were a couple of erythromycin
variants that were less irritating to the stomach but proved toxic for

other reasons; erythromycin estolate is the only one I can remember
but
I think there were two.


The estolate is associated with liver cancer.

However the other one, ethyl succinate form is no more and no
less dangerous than the regular erythromycin, right?

I looked it up. One counter-indication is arrythmias. Oh great.
That was my main complication for a while and no doctor ever said
anything
about erythromycin and arrythmias.

I could mention Viagra, etc. and erythromycin, but it would start
up too many jokes. But it's true. They potentiate each other. Why?



There are clones of the BEAM unit, fairly cheap, 1/10th the cost,
so it's
possible for anybody, who instead of going for the top of the line
SUV,
opts
for a slightly smaller vehicle, and can also have a BEAM unit or
equivalent to
see where the brain is going to go today.

Again, it's not just observing an effect, but determining if there's
anything clinically useful that can be done with the information.


This is really for the consumer to decide. It's like one's own guru
machine.
But EEGs can be portable and can be used at home and are now quite
cheap
that can even do brain mapping. One cannot play with PET or MRI. Too
expensive and need other people to help run the stuff.

But who knows how to do it clinically?
Neurofeedback therapists specifically.
But who would care about optimizing brain function?
If it's not pathological, then that leaves out the neuro-quacks.

So it's a gray or grey area.

But Broca's area is in the frontal lobes. And Wernicke's area is
a bit further back but probably not relevant unless you had
trouble with "content" words too in what was aphasia?

The frontal lobes are easiest to play with but the most messy
because of the big-time artifact from the eyeballs usually.
A lot of delta is supurious, just muscle movement from the eyeballs.

I do not know how much of Broca's area would be at the scalp above it
or how it would be studied with EEGs.

I don't think anyone knows about "training" it or using it
"clinically."

I would prefer "optimization" - sounds less pathological.