Occasionally Preposterous, Repeatedly Scrutinizing, and Sporadically Egotistical: My Two Cents

So you’re really tired all the time? Yes and the sky is blue. You got a flat tire? Yes and I got a cold last week. Your hair is falling out? Yes and my thumb started to peel a few weeks ago. Are these connected or non-sequiturs? A more common example of a non-sequitur would be tress are tall, giraffes are tall, so all giraffes are purple with beige dots. The hairloss and the peeling thumb are what inspired this post today. Taking a break from antibiotics for today.  The patient is a 64 year old female with diffuse hairloss over the last 6 months. New medications? No. Family history? Only her dad at age 85. New stress? Nope. New shampoo? Negative ghost rider. Any bad bouts of illness in the last year? Oh hell nah bro. Hmmm ok what could it be then. She did start to notice her thumb started to peel and the tip developed paresthesia. No burning, ulcerations, redness, not tender, grossly normal appearance. Hmmm times 2.  Is this related to her hairloss? Hell if I know. Neither doe...

I want to understand why I hear so much shade thrown at Piperacillin/Tazobactam or Zosyn, which I will now call PipTaz. The googles tell me there is a significant risk of liver injury. Is that it? On Epocrates and other googles, it seems to be about $20 a dose. Is that accurate? Is that why it gets hate? Please tell me or just point me in the right direction. I’m getting a lot of Indian pharmacy websites. I did find this in an article from the International Journal of Infectious Diseases  that " economic analyses have shown that generic antibiotic treatments during a 5-day hospitalization cost on average US$ 45.5–98.2, while the use of innovators can cost US$ 106.2–463.7." Down to brass tacks or tax, I never know. Piperacillin is, guess what? A penicillin which means it has the good old beta-lactam mechanism of action. Disrupting the peptidoglycan wall by binding to the PBP and causing the cell to lyse. It is enhanced to allow entry into gram negative bacteria, something abou...

I am guilt of assuming things. Less so as I learn more but still, it happens. What do you assume? Somnolence follows this blog, a BM follows Miralax, elation after ice cream. Assumptions however, while they have a place, should not overrule analysis. It’s a fine line between making a decision and pondering endlessly, guilt as charged. But do you jump to assumptions when a patient tells you something?  We get a lot of questions as my cohort studies for the NCLEX-RN that go like this “the patient looks like they’re dying, wyd?” See? Wyd. I’m hip with the jive. The answer is always some form of assessment not action if they don’t give you more information.  A patient with tanking O2 sats, throw a NRB on them? Or are they choking and the mask wont do anything or at worse, shove the offending object deeper into the airway? I’ve never had this happen I’m just spouting off.  A common one I see, looks like superficial trauma. Assume the patient just scraped their nose or think ab...

I write these on the elliptical. That’s it. No jokes here. Only my tears as I feel left out of jokes made by the medical and ID twitter accounts I follow but don't understand yet. Aside from that soul crushing fact, these antibiotic blogs are not only interesting to me but keep me on the cardio equipment at 0400.  So, ampicillin? Change the ox for the p, is it that different than amoxicillin? Kinda. It has a similar coverage but unlike amoxicillin it can be given IV and IM (amoxicillin can be given IV just not approved here in the U.S. of A). It is also a beta-lactam antibiotic, well distributed in body tissues, and widely used in pregnancy for infections such as group B strep.  What I think of, as a nurse, is the short half-life up to 90 minutes and the need to dose every 4-6 hours depending on kidney function. Also, as an outpatient drug? If I didn't have 3 extended release prescriptions I could take in the AM I don't know how it would be to have to remember to take somet...

  Birthday party, cheesecake, jellybean, boom. Thank you R.E.M. for a nice little ear worm. Here is a short post, and before you say anything, no I have not seen the last of us. I can’t sit still for more than 10 minutes. But I do find apocalyptic fungi pretty interesting.  Candida is the most common pathogenic yeast in humans. Insert witty joke about bread consumption here. It is also found in our guts and is probably most well known for thrush in immune compromised persons and genital yeast infections with antibiotic use.   Candidiasis is a not uncommon occurrence and cutaneous manifestations are quite ubiquitous. For the skin infections topical antifungals are generally sufficient. For candidemia, oral antifungals are required and may need courses from 2 weeks to lifelong therapy depending on the circumstances and source.  Ok but I want to talk about a recent article about C. auris  and some of implications. Though for us laypeople this may be new, it really...

I once took 3 weeks of Ancient Greek in high school. By take I mean I went, and though now I see and understand the influence that language had on our English language, I only remember two words.  Ton dulon . I can’t find anything to back this up, but I remember our professor hunching his shoulders as he described ton dulon as the “slow, lumbering yoked oxen at work” and for the life of me I don’t know why that stuck with me. My only affinity for Greece is Greek food and beaches. But all that rambling was just to talk about the word oxen so I could transition flawlessly to oxacillin. The next antibiotic in my “list” (I don’t have that much organization).  Oxacillin is a second generation penicillin. And we all remember how those work right? Beta-lactam rings and the destruction of the peptidoglycan of the cell wall? Of course you remember. But this is for me so I remember. Oxacillin is primarily used for Staph and S trep infections, especially those what produce beta-lactamase...

Amuck, amox, if you are as loose with your pronunciations as I am you can make almost anything sound similar. Similar you say? What about all these damn "cillins"? Amoxicillin, ampicillin, oxacillin, nafcillin, piperacillin, what's-that-on-the-cillin? I could keep going, but for your sake I will not. But seriously, what's with all these cillins? Last blog entry I did a little bit on penicillin and this week, amoxicillin.  Enough with the teasing John, just give me the lowdown on amoxicillin. Since you asked so nicely here you go. Amoxicillin is an amino-penicillin, adding an amino to a penicillin. Don't ask me what that means, aminos to me are something in your preworkout. So is this a buff penicillin? Well, the amino group changes its structure to allow evasion of some methods of antibiotic resistance. It is still a beta-lactam antibiotic, so it breaks down the cell wall like the cool-aid man which causes cell death.  Quick aside. Bactericidal means to kill the b...

For some of us the only glimpse of war we know is what is on TV. New conflicts every year it seems, we will never lack for violence in the world. But have you heard of the war that’s been going on for billions of years? Yup, on the scale of probably trillions of trillions of trillions of casualties. No end in sight it’ll probably go till the end of time. The war? Microbe versus microbe.  Now days we think of the war as man versus microbe and that is where I will take this and subsequent posts. I wager everyone know broadly what an antibiotic is. A molecule that kills life, “bio.”  What makes this come to mind? Penicillin, amoxicillin, and doxycycline are probably three of the more recognized drugs. How do these work? Where did we find them? Do antibiotics only kill bacteria? Let’s see what we can answer here.  Antibiotics as mentioned above are aimed at bacteria (some also work on parasites) and can also be used against cancer but that is for another time. They fall under...

Infectious xylophones? Am I talking about Gone Daddy Gone by the Violent Femmes? Maybe. Listen at your peril. But alas no. I’m talking about  Achromobacter xylosoxidans which I may now refer to a A. Xylophone  because you don’t need to hear me mumble my words more than I already do. So what is this infectious musical instrument?  The patient, a middle age female with an abscess on the scalp that had grown over the last week or so and become progressively more sore and tender. However, this was only the latest iteration in a years long cycle. A culture swab was taken and came back with P. Acnes and A. Xylophone.  I might have geeked out at the first, I had just listened to a Gobbet O’ Pus about a P. Acnes  joint infection. But the xylophone? What the h, e, double hockey sticks? I said hello to my friend the Googles to see what was up.  The xylophone is most often isolated from 60s-70s rock music. Oh wrong xylophone. It is most often isolated from the airways...

Alliteration, when I have no ideas that is my backup. I'm a world class alliterator, like an alligator with a motor. Expectations blown and I am not a clown nor down to crown an unwound town. Yes, windbag indeed. I warned you. Unlike my introduction, it makes sense to find mold on old food if you leave it out long enough. A chance encounter with a coffee mug that hadn't been opened this millennium inspired this post, in fact I think it was moving. If it is a new species I want it named after me, Aspergillus Johnneia or Blastomyces Kruegectis .  OK enough blabber. Fungi are pretty ubiquitous, from the small pin point of black mold to the largest 3.5 square mile fungi in the Blue Mountains of Oregon. There are an estimated 1.5 million species of fungi, though we only have found 150,000 so far, those are rookie numbers says Matthew McConaughey. It seems like frequently there is some notice from the FDA about a food borne outbreak. The usual suspects are E. coli, campylobacter, sal...

 Today will be a short post. Brevity? What’s that? Like gravity? Going to start doing these every 1-3 days depending on the alignment of the moons of Jupiter with Mars, Betelgeuse, Mount Everest, and the shadow of the Washington monument. Yes really.  Cancer is interesting and a continuing problem in the world. Is it because we need more of President Biden’s cancer moonshot? HR 4414 approving coverage under Medicare for more cancer prevention and care coordination? The National Cancer Act of 1971? The myriad organizations dedicated to cancer research like Miles for Melanoma? I don’t have the answer, don’t look at me like that.  I write this after I read an interview with  David Fredrickson, the executive vice president of oncology business at AstraZeneca. Pretty interesting, it’ll be in the resource section. But is there really anyway to prevent all cancer? Anyone who is alive knows that as time goes on, things start to go bad. Usually joints but maybe you also think...

 Colon cancer. Scary stuff eh? Chances are you know someone or someone who knows someone who suffered from colon cancer. It’s something in the back of my mind given that it ain’t all that easy to do a self colon examination. Even if some people might say I have my head up where the sun don’t shine. So what’s the big deal? It’s the third most common diagnosed cancer and third most common cause of death by malignancy in both male and female according to 2022 data from the American Cancer Society   Ok, have we made no improvements in dealing with colon cancer? We have, over the last 40 years the rates of death have dropped 56% which is pretty great (understatement for those with loved ones who’ve suffered from colon cancer). This is such a huge topic but I’m only going to cover one article from a Medscape email I received   Rates of decline for colon and colorectal cancer (I’ll now call them CRC) have slowed between 2011 and 2019. This is driven by an increase in the rates o...

 Martini, alveoli, abaci, smelly. I could go on. I have a minor talent of making jumbles of similar sounding words. I charge $50 an hour for anyone who needs someone with that particular skill. A bit of self aggrandizing, I got feedback on a paper that said “it was a pleasure and a privilege to read your insightful paper, and I thank you.”  Ego much? You got it buddy. Did you come here to listen to me brag? Probably not. Did you come her intentionally? Probably not. Majocchi.  Great Segway, I know. What the hell kinda cuisine is Majocchi? Think truffles and porcini, or Dermatophytes. Yes fungi, probably don’t eat it thought, might make you sick and I guess cannibalism is frowned upon. Let’s get to brass tacks (tax, tacts, facts). Majocchi’s granuloma is a deep, fungal folliculitis, that is an infected hair follicle. Maybe from an ingrown hair or a razor cut which allows the microbe to break into your skin. It is pretty uncommon and the risk factors are shared with many ot...

 “And make it double” Team Rocket. Yes. A Pokémon quote. I don’t apologize, I have no shame. Is two always better than one? Two scoops of ice cream? Better. Two broken fingers? Worse. Two infectious microbes? Better? But for whom? Not humans that’s for sure. Enter Wolbachia and mosquitoes (or Wuchereria bancrofti also). Wolbachia is an intracellular parasite that does some awesome work for its hosts, namely the above mentioned mosquito and parasite (a cause of elephantiasis). For mosquitoes it offers higher levels of resistance to pesticides. Sounds awesome right? In Minnesota our state bird is the majestic mosquito, and I can promise you hell is filled with nothing but the little bastards. Hellfire ain’t got nothing on mosquitoes. The little flying demons also become more resistant to certain RNA viruses like West Nile, norovirus, and chikungunya virus. Which is actually helpful. An article in PLOS 2008 found that mosquitoes infected with Wolbachia had a 2-3 times lower chance of ...

 Who doesn’t love a good whodunnit? I’m this case, whatdunnit?That’s part of why I love my job in the healthcare field and as an analyst, trying to piece things together to find a big picture or get a short glimpse into what might happen. Bag of chocolate covered cherries or bbq chips disappear? Probably my fiancé. Birds chirping when I wake up? Getting close to spring. Buildup of Ruskies on the Ukrainian border? Probs and invasion. But a WBC count of 1 I’m a healthy young adult? Hmmmm, as the kids say “idk bro”. Do they say that? Idk.  A 23 year old patient was admitted with pancytopenia after spontaneous bleeding from the gums. Not uncommon if you brush with the fury of a belt sander. Spontaneously? That’s weird. So the labs show severe pancytopenia as mentioned, WBC of 1, RBC of 2, platelets of 6, and ANC of one. Side note, what else do I need to see here? For anyone with experience let me know what else you’d look at. Спасибо большое.  My favorite person in the hospit...

There are many things in life that are better as duos. Synyster Gates and Zacky Vengeance, peanut butter and chocolate, peanut butter and fried eggs, peanut butter and literally everything else, and John and Abby to name a few. You get the idea. Something about the slightly, almost sweetness of peanut butter with a savory runny fried egg is just heavenly. I could go on, and I might. Ever had peanut butter pancakes and a beer? Best breakfast ever after a 12 hour night shift. Just saying. Another combo? NSAIDs and acetaminophen for back pain.  Back pain, specifically low back pain (LBP) is pretty common with worldwide estimates of 7-8% of people suffering from some level of LBP. Likely an understatement, especially because some people (maybe me) refuse to admit it until it becomes a really big problem. Either way, at least 577 million people as of 2017 have some LBP, likely even higher given that most of us can sit on our butts to work from home now and we all have terrible posture. ...

 Well no, quadrology isn't a word. But isn't quad four? Yes but tetra according to Merriam-Webster is "2 of 2 combining form : having four parts". Now that we have that sorted out, what about Fallot? The French keep dropping letters from their words but I prefer to pronounce them in a bad southern accent while keeping the T in there. Regardless, ever noticed how many conditions were named after French doctors and scientists? Heck, we named out fried potato sticks after them. What was this post about?  Yes. Tetralogy of Fallot which I will call ToF, a congenital heart defect that includes a foursome of cardiac defects; pulmonary stenosis (narrowing), ventricular septal defect (a hole in the wall), right ventricular hypertrophy (getting swole but not at the gym), and overriding aorta (its too darn big). The etiology is unknown with a certain portion being attributed to untreated maternal diabetes, ketonic acid, PKU, trisomy 21 and other genetic mutations, and everyone...