Medicine is an extremely fascinating and intriguing field and what is most precious is to study the gift of thought that has been given to Man. "We think; therefore, we are."
The first case on the video is of a lady that has an Amalgam Tattoo, benign. A dentist that saw the lesion panicked and tried to refer her to an oral surgeon. She consulted me instead and no surgery was needed. I followed this lady until her death of pancreatic cancer. Continuity of care with one provider is not only sacred, it is clinically important. A fragmented, market-based, healthcare system is absurd; it is too expensive and leaves many without insurance (47 million in the United States).
The second case is that of a white male with fibrosing basal cell carcinoma. When it was small, l/4th of inch, the HMO ignored it as nothing. Now he is uninsured, and it is going to take me a lot of work to cure him under local anesthesia. The biopsy took me less than two minutes. I applied a local anesthetic to small part of the lesion, and I performed a 2 mm punch biopsy. I cauterized the wound with silver nitrate. The whole procedure took me less than 5 minutes. Interesting, he was consulting me for acute prostatitis and then he said, "Can you look at this little rash?" It was all done a few months ago for less than $100.
The third case is of a 17-year-old with cellulitis that developed from the right foot, dorsal lateral aspect, after an insect bite. At first, he was very toxic, had high fever and his right groin was hurting (2ยบ inguinal adenopathy). It finally resolved by treating him with two different antibiotics. He developed oral thrush (Candidiasis) due to the antibiotic, which resolved with Nystatin suspension. Why was he able to open his mouth so well? His brother has Ehlers-Danlos Syndrome (EDS). This patient's temporomandibular joint is hypermobile and seems to have a less degree of EDS. I treat my patients collectively and the data gathered allows me to connect rare events into an elegant form, which I find fulfilling.
The fourth case is of a young male with acute Hepatitis A. He looked well. If a patient seems toxic, the clinician must consider systemic bacterial infections, i.e., pneumonia, sepsis and infrequently Leptospirosis. Acute hemolysis can present with icterus (jaundice) and clinicians must keep this in mind. At present, some doctors are treating children with ear infections (otitis media) with Zithromax® oral suspension. Zithromax can cause jaundice. About two years ago, a girl was treated with this antibiotic and almost lost her liver. The clinician has better choices in the treatment of ear infections, especially if the child is not allergic to the penicillins. I still prefer Amoxicillin since its absorption is about 85% and there is less risk of pseduomembranous colitis, as compared to Ampicillin. Education paid by drug makers can hurt your patients. I don't trust the selective data they try to give us. It is often wrong and biased.
The next case is of a child with a non-pigmented nevus, benign.
The young girl I adopted out of Welfare is my half-sister, as well. My mother, while I was in high school, met a deadbeat dad that had kids all over. As soon as my sister was born, he abandoned her. By then, my mother was not at her best, and one day I took her to court and adopted my own sister. The welfare system is very good at dispensing our money without insuring that the responsible male (impregnator) is held accountable in some form. The system is collapsing. It is sad. All societies need a safety net in the form of limited social Welfare.
We need to reform our healthcare system at various levels so that the funding goes to the patient, nursing staff and physicians with medical value and medical infrastructure. Amgen Inc., a "powerful powerhouse," is at present boosting its capital lobbying. According to the L.A. Times, "Amgen now has more than two dozen politically connected lobbyists and consultants on the payroll." Amgen is in second place, just behind Pfizer, (Pfizer Inc. is the largest drug maker in the world; Pfizer lobbied, at the expense of humanity, to keep pseudoephedrine legal). According to the Los Angeles Times, Friday, August 17, 2007, Amgen, this summer, "held a fundraiser a its Ventura County headquarters for House Speaker Nancy Pelosi. Are we being governed like a third world banana republic? Our politicians make strange bedfellows. We need a third party, now more than ever, and we must make PSEUDOEPHEDRINE, THE DESTROYER OF LIFE, UNAVAILABLE.
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Wednesday, August 22, 2007
Hepatitis and Lomeli Medical Data 82108
Thursday, August 16, 2007
The poor little girl Just wanted her beloved dog treated.
The little girl just wanted her dog treated but had no money!
Many years ago, a little girl was sad because she could not afford to pay the veterinarian's excessive fees in order to treat her dog's chronic seizures for the previous five years.
The VET (veterinarian) first wanted to perform a film of the abdomen in order to see if the liver was enlarged. It was an absurd approach since an x-ray/film of the abdomen would yield the least data. The clinical approach is to perform an ultrasound of the liver.
The VET made her feel bad for not "allowing him" to properly evaluate and treat her pet. The VET then said he might have to do x-rays of her dog's head. The blood and urine tests that were being recommended cost hundreds of dollars.
I decided to examine and treat her little dog, Charlie, for free. If a patient presents today with a new onset of seizures, a head CT scan would be appropriate. If a patient presents with a recurrent but stable (non-progressive) history of seizures for 5 years, the diagnostic work-up, though profitable, would yield very little.
Charlie had exertional seizures (epilepsy) but was otherwise well. The physical exam was normal and the liver did not appear clinically enlarged. I did simple tests and a urine analysis. The tests were normal. Charlie's weight was appropriate for a dog of his kind.
Based on these data, I put Charlie on Phenytoin (Dilantin®) at a 5 mg/kg/24 dose that was to be given once per day. Since he weighed 10 pounds, this translated to 4.5 kilograms. Thus, I dosed him at 5 mg X 4.5 kg = 22.5mg. Since it is readily available as a suspension, 30 mg/5 ml, I simply had Charlie take a teaspoon of Phenytoin per day. I asked the little girl to keep an eye on Charlie and to let me know if he "walked funny" or if his eyes moved about strangely and to let me know if the gums grew too much. He did well and lived seven more years.
Later, while in high school, the same girl came to say hello and said to me, "Guess what? I am going to college to be a doctor just like you." What I did for this little girl (now a woman) and her little dog, Charlie, was rewarding and no amount of money can surpass the personal satisfaction I derived from helping them.
For those that wish to enter medicine, you must learn the following information. We know that a kilogram (kg) is equal to 2.2 pounds. Since Charlie required an average dose of Phenytoin of 5 mg/kg, and he weighed 4.5 kilograms, I simply multiplied 4.5 kg X 5 mg/kg = 22.5 mg. In the latter equation kg divided by kg cancels out this unit and you end up with the mg dose as written. Since the medicine comes in 30 mg per 5 ml (per teaspoon) suspension, I simple increased the dose to 30 mg per day, which is still well within the normal dosing range.
Am I qualified to do Pet Medicine? While in college, I learned to do complex brain surgeries on rats. You must realize that genetically we are not that different from a dog. For instance, a mouse and human have in common 90% of our genetic material (DNA). The difference between you and me is only .l%. Nature is magic and it doesn't reinvent itself as it evolves into higher forms (i.e. humans). A Medical Degree acquired in the United States is the highest cognitive degree one can attain.
About my dog, Corny, I have been his doctor for a long time. Once, Corny had a tumor over his neck (pictures will be shown later), and I excised it under local anesthesia. I cleaned up the tissue so that no hairs would be apparent and sent the specimen to a regular medical lab to be analyzed. The MD pathologist declared the tumor as benign and never figured out that it had come from a dog.
When you seek care through a VET, you can buy your medicines at a regular discount drug store at a fraction of the cost. In addition, a chemistry panel, CBC, thyroid panel and urinalysis should not exceed $70.
I look forward to the day when doctors are made to post their fees, and pet owners can take their pets, for blood tests, to an independent laboratory or imaging center, and not pay the excessive fees often charged by VETS.
This shall apply to dentists. We have more dentists than we need, but they simply keep inventing new procedures in order to make a living at our expense. Dentists too, must be made to post their prices as well as how much insurances pay them. Before you get all of your wisdom teeth taken out or "another root canal," you must ask yourself if you really need to have this done.
We as Americans are facing tough times. We need to protect the little money we may have.
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Monday, August 13, 2007
Her nakedness me want to vomit!
Her nakedness made me want to vomit.
When I was 3-year-old, my playmate was my first cousin Marbella. It was natural for us to bathe in the arroyo. One day I saw her naked, and I said to myself, "Oh my god, she's got a crack that must go from front to back." It grossed me out, and I no longer wanted to look. I was happy with my body parts. I was a liberated boy. In the fifth grade, I'd let Marbella peddle the bike while I rode on the handlebars. Marbella was sort of a tomboy. Once she said to me, after school, "You cannot say you saw it with your own eyes. It is redundant." We debated the point.
When I was 9-years-old, my aunt had left the shower door open, and I saw her naked, with hair and all. I wanted to vomit. I never mentioned it to my friends. It was too embarrassing.
Later as an adult, I dated a girl from Manhattan Beach. She was beautiful. We met for lunch near a local restaurant, the Kettle. She was wearing a short skirt and a bikini top. She looked great. As we ate, I noticed that her right breast was pointing up and to the side. It looked strange. The girl recognized that I had seen her breast out of place and said, "Oh! My breast implant is out of place; I am getting it fixed."
After lunch, she invited me to her pad. But I said, NO! I had no more (ganas) desire to romance her.
Thereafter, I found that the less flesh I saw, the more romantically inclined I felt. In darkness, one can create greater beauty than seems humanly possible.
While living in Torrance, I found that the most seductive force is simply listening to a woman. It can be more powerful than a song or a poem. One night, I met a girl at a club and she told me her life story. Listening to her story made her night, and I saw her eyes glowing as we ate at the Kettle.
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Wednesday, July 25, 2007
Lomeli Medical Data-Laboratory and More 777
July 7th, 2007
Description is not complete. To read the data in the video, you must pause the film.
I'd like to make a comment to my fellow Americans and our private industry. We cannot afford to support 2000 insurance companies; these are artificial jobs. The market is controlled in a manner that the costs keep escalating to the point that is causing unemployment, job loss, and outsourcing. I had to close, for the most part, my clinic for the poor. Government expenses make the delivery of healthcare even more expensive. Many in government have created unnecessary jobs out of healthcare.
In order to get out of bankruptcy, Dana Inc., had to dump healthcare for retirees. Detroit's Big Three automakers will have to do the same thing if they are to compete with the Japanese automakers.
Properly so, "U.S. automakers and many other manufacturers have complained that the cost of retiree health has let them unable to compete with foreign companies with lower labor and benefits expenses." The Los Angeles Times, Saturday, July 7th, 2007.
Behind the scenes, I am working with very smart people in order to make healthcare more efficient and responsive to the needs of our patients, not the healthcare industry, specialists, drug makers, or insurance companies.
We must empower all Americans so that they promptly receive the proper care through knowledge. At present, our healthcare system is not punished for being inefficient. How often have you had to see your HMO doctor before getting the proper care, if at all? What about hospitals? Patients go in with one condition and they acquired another serious conditions, which is often fatal.
It would be less expensive and safer for the hospital (via private industry) to come to patients. Hospital acquired infections kill thousands of people each year. Hospitals can charge for the added healthcare costs though they caused the secondary and often fatal complications. Half of all healthcare costs are spent in the last two weeks of life. We must readjust reimbursement so that it reflects value: Life v. Cost.
Not all doctors are created equal and patients must have a say as to the fee paid to each private doctor. Certain specialties can be arranged in a manner that saves us billions of dollars each year. I will reveal details later.
It pains me greatly that my absence is causing many of my patients to acquire expensive healthcare costs or die. In the end, I hope the sacrifice shall be worthwhile.
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