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

Betcha got that stuck in your head now. Or not and I am just easily amused. A while back I talked about a patient I cared for with pancytopenia. A seemingly otherwise healthy young man, with low everything and negative tests (when he was on my floor) for malignancy and infection. As I so famously said back then; what the hell?  Let’s quick recap. The bone marrow is the origin point for many of the cells that make up our blood, some end up in other tissues to mature into their specific role in the body. Screwing with one of those steps (simplified) can really throw a spammer in the works. I’ve made the analogy before about it being easier to intervene in an earlier stage than a later stage. Think a construction site vs skyscraper, 6 weeks pregnant vs 30 weeks, etc… EBV is an outrageously huge subject so I’m just skimming on part of the surface. First, if you want a much better idea of what this is, listen to the EBV episode of This Podcast will Kill. YouThat’s Epstein-Barr Virus FYS...

Oh sure ya betcha, discussing an unfortunately polarizing subject why dontcha? Oop, yep you bet yet britches so sit on the davenport and grab ya some tater tot casserole. No vaccines are not from Minnesota but I am. When I record this podcast I might just do the whole thing with a bad accent. You’ll have to wait and see.  Everything has some controversy, or controversy (imagine a British accent) and vaccines may be at the top of the list. The amount of information, studies, anecdotes, and “studies” you can find on the subject can be overwhelming. I’m surprised our robot overlords had enough disc space for it all in the matrix. The list of arguments against vaccines include toxicity of additives and adjuvants, use of fetal cells, microchips, instigation of autism, death, and the list can go on. This is not that blog post, tune in for subsequent posts for that shtick.  Vicarious means to experience something through someone else or by the action of another. It is also a classic ...

 Yay! Back to antibiotics! Life is busy but good, but not too busy for the occasionally preposterous blog reader. Yes you. You’re the only one so hello. I hope you’re happy, this one’s for you buddy.  Working our way through as many antibiotics that I can write about, we are moving from the ever lovable cephalexin to the younger siblings: second generation cephalosporins. Specifically cefuroxime, another beta-lactam antibiotic. Right now you may be thinking why the hell do we need another one? Because people are not smart when using antibiotics willy-nilly and causing resistance, so it is kinda important to keep finding new ones as we just to get smart about what we do have.  Anyways, cefuroxime (and most second gens) have longer half-lives than their first gen counterparts which allows for less frequent dosing. This is, as mentioned previously, helpful for patients who may have a lot of different medications they take daily. This dosing is PO or IV by the way. Secondly, ...

Why this topic? I’m currently listening to “Under Black Flags we March” by Arch Enemy. Angela Gossow is so hardcore. Speaking of hardcore, show of hands, who tried to prove their hardcoreness in 104F heat before? Just me? There is a reason we are called jarheads. Anyway, I promise this makes sense. Black flag is the marker used on pirate ships. And for weather conditions with a high risk of heat related injuries. That is what I am getting to.  For those of us who live in a place that goes from -50F to 100F we can get frostbite and heat stroke both in one week. So much fun. Sweat is one of our body’s compensatory mechanisms to cool us down. Evaporation of the sweat removes heat from the skin, if everything works well and we drink water and have enough electrolytes, we don’t overheat. Remove the water and salt, then we can’t sweat and we start to heat up like a car with a busted radiator  Loosing fluid via sweat and no intake means that the body has to ration out what’s left bet...

Actually shocked, shooked, shooken, shicked, shucked, stucked, chuffed. Are some of those not words? Probably. Do I care? Not a chance buddy. But that actually has something to do with the subject and f the post. What? Getting to the point right away? I don’t think John wrote this. Shocker, I did. And it’s shock.  Specifically neurogenic shock. In short, shock is less oxygen and/or more oxygen use and/or ineffective oxygen use leading to hypoxia and tissue death. If you remember my wise words from the Tetralogy of Fallot post, oxygen is important kinda. This can happen for a few reason but today it’s neurological. When I hear neuro I think brain and nerves and spine, which give you a clue to the cause.  I’ll call it NS now, to to be confused with normal saline or not so or never seen or new spatula. NS is classified as distributive shock, that is the body’s logistics system isn’t working. Kinda like ours. Anyways, this means even if you’re getting oxygen in, it doesn’t make it...

I’ll give a prize to anyone who can tell me how the title relates to cefadroxil. Seriously, I don’t know but I couldn’t think of a better title for a drug that sounds like a Pokémon or something. Actually, that is true and so is the title. Bingo bango.  This time I won’t write a page of preamble before getting down to brass tacks. Cefadroxil, the brother of cephalexin, a beta lactam antibiotic, and a first generation cephalosporin. Case closed.  What’s the difference between the two? Or between the other 657,326 other first gen cephalosporins? At least comparing cephalexin to cefadroxil there are a few differences. Cefadroxil is cleared slower or more slowly, or slowier from the body than the cephy. It is generally given Q12H or QD as opposed to Q6H to Q12H. Cefadroxil is given in higher doses (generally) 1-2g/day versus 1g/day. Both are time dependent mass killers of bacteria, kinda like when you spend too much time with that friend who doesn't shut up it ends up melting your...

The first time I met my future mother-in-law we had to move 10 or so horses an hour from one farm to another in a 3 horse trailer. All of the tac lockers and gear had to move too and I am a fantastic pack animal if nothing else. It was an interesting evening but if you ever want to leave a good impression, you should try it. I also lost my arachnophobia since I didn’t want to scream like a toddler every time I came across the devil incarnate. Still hate spiders, but I only shoot once now.  What was the point of that? Horses. Zoonotic diseases were a common talking point of the masses after COVID-19 started its world tour. The same thing happened after Ebola’s debut on the scene, when HI  pulled a Cool-aid man wall smash out of primates, and after the MERS pulled a Snake Plissken and escaped dromedaries like he escaped New York. But we have an extremely short memory so really, who remembers those events? What events? What was I talking about? Oh hi my name is John and this is m...

Doesn’t roll of the tongue quite as well. Maybe 20,000 leagues under the epidermis? The Rash Awakens? Revenge of the Rash? No. It’s not relapsing so that won’t work. Anyways, I got a mystery. What the hell is this rash? I promise, it’s not that kinda rash.  It starts as small blisters. Bilateral forearms and hands. Not painful but tender, they pop and the liquid is typical blister juice. Not purulent, not green, not smell. I haven’t tasted it so I can’t speak to its bitterness or otherwise. With any wound, they are tender and sensitive, and don’t seem to have any aggravating factors.  The patient is an otherwise healthy 30 year old male with a history of major depressive episodes, superficial veinous thrombosis, pulmonary blasto 20 odd years ago, urinary frequency, and the ‘rona at least once. BMI of 23.4, active, mostly healthy diet, works in healthcare. Has every vaccine imaginable including anthrax and four COVID microchips, I mean vaccines. Takes bupropion, fluoxetine, fer...

Yummy. Liver. Can’t imagine why so many people think it’s gross. You probably eat the stolen children to be of chickens without a thought. And what about pickles? Little cucumber just walking along and bam, forced to conform to life as a pickle. Exaggerating much? Sir yes sir.  The liver is a fascinating organ (most are to be honest). It plays so many roles in the body and is linked to so many disease states. It’s so important it even gets two blood supplies and can regrow after insult, unlike my ego. I will do a few posts later on hepatitises. Is that hepatiti? But today, iron.  The liver is an important storage site for iron in the body and also plays a role in the breakdown of red blood cells. Bilirubin is something you might hear of a lot, that is the product of the metabolism of heme from the blood. Increased bilirubin production and RBC hemolysis lead to a buildup of said bilirubin and causes the yellowing of tissues known as jaundice. Any time your body doesn’t oust sub...

Conflict is the meeting of two opposing ideas. Like me and pop music. Or pancakes and waffles (except chicken and waffles). Or my shoulder and literally anything. You get the idea. What does conflict bring to your mind? Fighting? Battles? Angry people? Animosity? That sounds about right to me. Merriam-Webster says “incompatible or opposing needs, drives, or wishes.” Sounds bad? But is it? As an analyst I have to know some history about my area of focus. Was the conflict between the United States and the USSR bad? I would argue it had a good outcome overall but you can message me or comment if you disagree. I would love to talk about it.  Did you come here for a Cold War history? I hope not but I could. The History of the Cold War podcast is excellent, the gentleman who produces it knows way more than I, and has a much nicer voice (and mic). All that to say, no I’m here to talk about inter-organizational conflict.  I know a lot first hand about conflict. The military and Marine...

I’m only kinda vain I promise. I’m a firm believer that men only go to the gym to impress and intimidate other men. Health? Nah. Women? Nope. Just as I am convinced women use makeup and botox (yes I know men do too, calm down) for other women. All that to say, cephalexin.  Flawless transition, chef’s kiss.  Before I worked in healthcare I knew about penicillin and doxycycline. Penicillin because I was sick as a kid, why didn’t I know about antifungals then? Doxycycline because I was supposed to take 18 months of it in Kabul. I’m pretty sure I have all 540 some in a bottle somewhere as a souvenir. That’s old news, today? Cephalexin all day and all night and all day. Yes, that much. But why? Cephalexin, or cephypoo as it is known. Is a first generation cephalosporin and a beta-lactam antibiotic. As was penicillin. Quick recap, beta-lactams inhibit cell wall synthesis and synths (they hate 80’s music) by binding to PBPs and doing to the peptidoglycan wall what the US Marines did ...

Insert a Jack Nicholson in the Shining “I’m back”. Or don’t, either way I am, not from being gone but from writing about antibiotics, and bringing a post on dicloxacillin. What is that you ask? No. I’m kidding, you don’t ask but I’m feeling you anyways.  Truth bomb: it’s a penicillin, if you didn’t notice. Truth bomb part deux: therefore it be a beta-lactam. Yes it be and it do. What does it do? Mess up the cell wall by binding to PBP like the Korean Zombie messed up Dustin Poirier. But unlike the Korean Zombie, it has a narrow spectrum of activity against staph  infections. It is recommended for use only on culture confirmed beta-lactase producing mild to moderate infections. Which, to take a minute, seems very subjective. Like mild and moderate salsa. My white guy tongue thinks moderate is fire and mild is almost too far. As I write that, I did find out how they differ. Mild is superficial and limited, moderate is deeper, and severe is metastatic, systemic, and effects metab...