Archive | August 2023

QUOTE FOR WEDNESDAY:

“It’s natural for your mind to recall painful events. But if these thoughts are interfering with your everyday life, there are strategies that can help.

There may be some things you remember that you wish you didn’t.

Maybe you lost someone or something close to you or close in dealing with in your life, or there was a divorce you didn’t see coming, or you were let go from your job in a painful way.

It’s easy for these kinds of memories to keep you up at night. But there are some expert-backed ways to help you process and integrate painful experiences.”

Psych Central (https://psychcentral.com/health/letting-go-of-the-past-why-memories-remain-painful-over-time)

Don’t let bad memories control your life and some tips in how to deal with them!

 

Consider 8 Ways to Heal:

1. Psychotherapy can help identify past trauma.  Let the unfortunate trauma that happened to you diminish in time with doing things to deal with your stress or past traumatic injury you experienced but you become determined not to let those wounds ruin your life today.  If no good memories came out of it don’t dwell on it and turn into someone whose bitter or whines all the time.  Show the world your dealing with it and got over it!!  Your now a stronger person.

2. Grief requires dealing with your deceased parent; warts and all. You accept that you were traumatized; you may even forgive and if traumatized in a way in losing something or someone remember the good memories it gave you or in just a loss of a one you loved with all good memories remember that.  The hole in your heart is a mental injury like all types it will heal in time.

3. Identify your triggers. Everyone who’s been traumatized has triggers and responses. Get to know yours.  Utilize what calms your trigger down whether it be work out or hobbies or some type or work.

4. The Trigger-Response recreates the past. When you run, freeze or attack, you end up recreating and therefore, re-enforcing the past. You freeze and people think you are cold and stonewalling. If you run, nothing will last. And, if you rage in response to being triggered, you are doing what was done to you possibly. People will withdraw or be injured; not a good outcome.

5. Good therapy also helps you to rediscover your strengths. We are not just damaged creatures, but also living beings with power and talents. Many people discover strength they never knew they had in treatment. This, in turn, gives you more motivation to overcome  the trauma of your youth. With competent psychotherapy you may be able to gain the strength to deal with being triggered, without harming others – or yourself. Happiness is that important.

6. Alternative treatments like EMDR, Somatic Experiencing and DBT may help as well. These treatments help with muting the triggers that are neurologically embedded in your brain. Remember that the fight, flight and freeze response has an evolutionary purpose. It protects the organism from dangerous situations. You may need specialized expertise to overcome this programming.

7. Often trauma is found alongside other psychiatric disorders like Anxiety or Depression. An intelligent use of psychiatric medications can reduce the trigger-response effect and give you an opportunity to create a future response that is not dictated by your past.

8. Spirituality can be invaluable. No one can tell you HOW to be spiritual, but for many, some form of faith can truly detoxify. (As long as you are not in a faith that makes you more anxious and burdened.) People may have hurt you, but a new life is yours for the taking. Look up at the stars. Smell the fresh air. Sense the opportunity in every moment. And, know that you are part of something larger than you. It settles the soul.

The Power of Letting Go: We often speak of the dead with the words;

“He (or She) Should Rest in Peace.” Yes, they should.

Yet, we often don’t think about the ways that people who are gone still impact us, even though they are not here. Your mom or dad may be gone, but their hurt remains. And, you have some choice to live a better life despite what happened to you.

Open your door the past does affect it now possibly with negative thinking or responses but the present – and the future higher odds does not.

But, contemporary psychology opens the door wider. You can be free from your past.

It starts with consciousness. Then, the journey is all up to you.

 

About the Author

You are reading

The Intelligent Divorce

Parents, Cyber-Sex, and Children

The shocking things kids discover about their parent’s social media.

How Young Are You?

Is chronological age simply a construct?

The Borderline Dad

How borderline fathers can act out in a divorce

Countries:

QUOTE FOR TUESDAY:

“More and more US adults are dealing with stress, which can lead to mental health problems.  In August 2022, more than 32% of US adults reported having symptoms of depression or anxiety in the last 2 weeks.  Quick activities to improve your emotional well being!

  • Be active—Take a dance break! Lift weights. Do push-ups or sit-ups. Or kick around a soccer ball for a few minutes.
  • Close your eyes, take deep breaths, stretch, or meditate.
  • Write three things you are grateful for.
  • Check in with yourself—take time to ask yourself how you are feeling.
  • Laugh! Think of someone who makes you laugh or the last time you laughed so hard you cried.
  • Find an inspiring song or quote and write it down (or screenshot it) so you have it nearby.”

Centers for Disease Control and Prevention (https://www.cdc.gov/emotional-wellbeing/features/reduce-stress.htm)

QUOTE FOR THE WEEKEND:

“Atrial fibrillation is the most common type of abnormal heart rhythm. Nearly 4 million emergency room visits from 2007 to 2014 in the United States were for atrial fibrillation. An estimated 2 million people in the U.S. have A-fib Complications arising from afib vary from Cardumyopathy to CVA (stroke), Low B/P,  CHF and more.”.

Cleveland Clinic (https://my.clevelandclinic.org/health/diseases/24578-atrial-fibrillation-with-rvr)

Part II What is RVR (Rapid Ventricular Rate) & Atrial Fibrillation?

Symptoms:

 Some of the symptoms of this disease atrial fibrillation RVR include Chest Pain or Discomfort, heart palpitations (described as unnoticed skipped beats or skipped beats noticed from experienced dizziness or difficulty in breathing), shortness of breath when lying flat (orthopnea), shortness of breath (dyspnea after exertion) sudden onset of short breath during the night (also called paroxysmal nocturnal dyspnea) and gradual swelling of lower extremities. As a result of inadequate blood flow, some patients complain of light headedness or dizziness and may feel like they are about to faint, a condition referred to as presyncope and may actually lose consciousness (syncope). Some patients experience respiratory distress that results in them appearing blue. A close examination of jugular veins usually reveals elevated pressure in some patients (jugular venous distention). When some patients are subjected to lung examinations, crackles and rales may be observed pointing to possible lung edema.

Importance of proper diagnosis:

A good diagnosis of the symptoms shown by patients is important to ascertain that the patient is suffering from atrial fibrillation with RVR.  This is because some forms or irregular and rapid heart rates, tachyarrhythmia, are dangerous and must be ruled out as they are life threatening – such as ventricular tachycardia. Some patients are usually placed on continuous cardio respiratory monitoring, but an electrocardiogram ECG is vital for correct diagnosis.

 How is it diagnosed?

 Simple, a typical 12 lead electrocardiogram (ECG). This test shows cardiac rhythms which atrial fibrillation is. Rhythms are made up of types of waves that the ECG shows which are P waves, QRS waves, T waves and U waves.

The QRS complexes should be narrow, to signify that they are being initiated by normal conduction of atrial electrical activity through the Intra-ventricular conduction system, or heart conduction system. Wide QRS complexes could point to ventricular tachycardia, although wide complexes may also be an indication of disease processes in the Intra-ventricular conduction system. The R-R internal will also likely be irregular. Meaning measuring from each R section of the QRS rhythm. It is also important to find out if there are triggering causes for the tachycardia which include dehydration, Hypovolemia – a decrease in blood volume, and more specifically decrease in blood plasma volume. You can go ahead to eliminate Acute coronary syndrome – which refers to any diseases that are directly attributed to the obstruction of coronary arteries.

How A Fib is treated:

1-A Shock

This is known as cardioversion and is used typically either when an immediate result is required or used when the Afib is of relatively recent onset or only intermittent, and so has more chance of staying in normal rhythm. In cardioversion a small shock is given using defibrillation pads. It is done under light anesthesia therefore it doesn’t hurt. The Afib may return however.

2-Rate Control Drugs

The biggest problem in Afib with RVR is too fast a heart rate. In a rhythm control strategy we use drugs such as beta-blockers to slow the heart rate down. These drugs typically will leave the patient in AF. For many people with AF it turns out that a rate control strategy is preferred as it is considered less risky than the rhythm control drugs used to get rid of the AF while being just as effective. In Afib with RVR rate control drugs can often slow the heart rate down fairly quickly and improve symptoms.

b-Rhythm Control Drugs

These medications are generally more powerful than the rate control drugs and attempt to convert the Afib back in to a normal rhythm. They are often given after a shock treatment to try and help the heart stay in normal rhythm. These drugs are also commonly used in hospitalized Afib with RVR patients. The problem with these drugs is that they may have side effects and associated risks. Many patients simply cannot tolerate Afib even if the rate is controlled and therefore require rhythm control drugs. They may be safe and effective however if used in selected patients. In cases of Afib with RVR these medications may need to be used if patients cannot tolerate other rate control medications.

3-Ablation Procedures

Ablation procedures are minimally invasive procedures typically done through the groin. They are typically used in patients that have tried, or cannot tolerate medicines for control of AFib. Ablation is typically not used as an emergency treatment of Afib with RVR, rather it is used for stable patients in AF, or those with intermittent AFib that wish to remain in normal rhythm. In patients that have had persistent Afib for a long time these procedures are not likely to be successful in the long term.

b-Pacemaker

This is typically the last throw of the dice for AF control. In some patients, drugs can either not control the rate in AFib with RVR, or the drugs can simply not be tolerated. In these patients who have no other choice, and in whom it is determined the Afib is causing harmful effects, a procedure called AV node ablation and pacemaker is done. In a relatively minor procedure, a small burn is made to the connection that connects the top and bottom chambers of the heart. A pacemaker is then inserted. This prevents Afib with RVR as although the top chambers continue to fire at a fast rate, the pacemaker now controls the bottom chamber, in a nice regular way. The downside of course is that now although the patient cannot have Afib with RVR, they have a pacemaker.

Acute afib RVR patients are more likely to be converted to Normal Sinus Rhythm (the best rhythm you could be in) as opposed to patients with chronic afib. There are complete resolutions for both kind of afib but atrial fibrillation in RVR the heart can handle for only so long and remembering the engine of our body is the heart so take good care of it for if you don’t it could allow you to die.

 

QUOTE FOR FRIDAY:

“Atrial fibrillation with rapid ventricular rate (A-fib with RVR) is a type of irregular heart rhythm. With A-fib with RVR, your heart doesn’t have a normal signaling process telling your heart when to beat. Instead, signaling is disorganized and the parts of your heart beat out of sync. Medicines and procedures can help manage this condition.  They have a heart rate of 100 beats per minute or more.

When you have A-fib with RVR, it’s difficult for your heart to pump the amount of blood it should. That makes it hard for your body to get the oxygen-rich blood it needs to function.”

Cleveland Clinic (https://my.clevelandclinic.org/health/diseases/24578-atrial-fibrillation-with-rvr)

 

Part I What is RVR (Rapid Ventricular Rate) & Atrial Fibrillation?

afib afibAFIB Symptoms.

afib RVR12Lead EKG with AFIB.

 

Working of the heart:

The anatomy to know in this discussion it you have 4 chambers and flow the blood through the heart.  Below is a picture of the heart showing vessels mainly carbon dioxide in blood=color blue & oxygenated vessels=color red.

  The Ventricles of the HEART

Our blood needs to be oxygenated and when oxygen is used up we have more de-oxygenated or high carbon dioxide (CO2) levels in the red blood cells in the blood stream that go to our lungs for oxygen from the right side of our heart, which is used up oxygen blood in our red blood cells to more carbon dioxide in the cell than oxygen.  So now those cells have to get replaced with oxygen and to that blood reaches the lungs from the right side of the heart pumping the blood, as its motility, to get to the lungs for more oxygen.

The RBC’s filled with more carbon dioxide are sent to the right side of the heart; first the right atrium to the right ventricle to the pulmonary artery to the lungs for more oxygen.

When we breath a oxygen / carbon dioxide process takes place at the bottom of the lungs.  We send oxygen down to our lungs and send out CO2 from our body to replace it with more oxygen.  This is how it works; when we inhale we send oxygen down to the lungs to replace the CO2 in our red blood cells (RBC’s).  We have to get rid of CO2 for replacement with oxygen.  When we exhale we send that gas, carbon dioxide, out of our blood stream and upon inhaling we send oxygen down to the lungs to replace the CO2 in our red blood cells (RBC’s).  That carbon dioxide blood in our RBC’s get sent out of the RBC’s leaving the membrane of the cell going into the lungs where a gas exchange takes place replaced with oxygen passing the RBC membrane into the RBC that’s in our blood at the bottom of the lungs that we get when we breath.  Those RBC’s that are now oxygenated are sent in the bloodstream to the left side of the heart where the heart pumps sending that oxygenated blood to all body tissues/organs to stay alive from the left atrium to left ventricle and sent out the aorta to all body parts.

When we do the process of  breathing it is what allows the exchange of gases to take place at the RBC’s.  Without oxygen we would have RBC starvation and we would be dead unless we where on a ventilator doing our breathing process.

Knowing this also know we have areas of the heart that play an effect with cardiac impulses from our natural pacemaker of the heart SA node in the right atrium that sends cardiac impulsed all the way down the heart to send messages to the heart in doing beating and function that is not discussed in this since it would be a chapters.  Know this part the SA node is effected which when its now we are probably in a rhythm NSR normal sinus rhythm but when the SA node doesn’t work other areas in the atrium take over causing other rhythms and one could be atrial fibrillation or not.

So now with a quick overview of the anatomy of the 4 chambers of your heart and the process of breathing for 02 and CO2 and a quick touch of the firing system at the SA node lets go into atrial fibrillation also known as afib.

Understand in atrial fibrillation you show a line that squabbly with a pointed line.  The squabble line is

To easily identify atrial fibrillation with RVR, it is vital to understand the working of the heart.

The atrium or atria (plural) is the upper chamber of the heart, the heart has 2 atrium.  Now, in size compared to atriums you have the lower 2 chambers known as the ventricles and they are larger.

The atria function by gathering blood as it flows into the heart and shrinking to forward the blood into the ventricles. At the very moment, the ventricle must shrink to forward the blood to all parts of the body. This rhythm of blood flow creates a heart signature voice referred to as the Sinus rhythm. It is important that the sinus rhythm is synchronized so that the atrium does not send blood into the ventricle out of cue. To achieve this, an electric signal is generated to ensure the atrium contracts. When this signal short circuits (bypasses) the atrium, atrial fibrillation with RVR occurs, and the atrium is seen to vibrate just like jelly on a flat surface (see the second picture posted above to see the rhythm).

Atrial fib with RVR refers to atrial fibrillation with rapid ventricular rate. Usually the heart is like clockwork, the top (collecting) chambers beat then the bottom (main pumping) chambers sense this and also beat, and so on, in a nice regular fashion just like a clock ticking second after second. Usually the heart beats at about 60-80 beats per minute.

What is Atrial Fibrillation and RVR:

In atrial fibrillation the top chamber basically goes crazy often firing off over 400 beats per minute! Atrial fibrillation with RVR (Rapid Ventricular Response) is a heart condition caused by irregular electrical activity that results in irregular contractions of the 2 top heart chambers fibrillating. This means the heart (atriums), shakes with a rapid tremulous movement or makes fine irregular twitching movements, generally referred to as fibrillating in the upper chambers of the heart (atriums) causing little control in the heart output of blood by the heart making the lower chambers called the ventricles to take over.  Know when the atrial chambers can’t work the ventricles take over but know this they are pumping a slower than 400 beats a minute and could range from 100 and up to 200 if not controlled.

These bottom chambers don’t allow all those impulses through but it does let every second or third one through. This can give a heart rate of 100-180 beats per minute at rest, still too many beats, known as Afib with RVR, leading to symptoms and problems with heart function. Afib does not necessarily lead to Afib with RVR however, Afib can be rate controlled, sometimes naturally, sometimes using medications and sometimes requiring procedures.

In most people with AFib although symptoms can sometimes be unpleasant it is generally not harmful as long as the afib is controlled, meaning the heart in the afib rhythm with the pulse under 100. The main concern is stroke, but that can be treated with the use of blood thinning medications in people at risk. In Afib with RVR, basically the heart is beating too fast. Of course palpitations are the most common symptom. Other symptoms of AFib with RVR may include dizziness, lack of energy, exercise intolerance and shortness of breath. If Afib with RVR goes on for too long then this may result in heart failure and of course worsening of existing heart failure. Control of the heart rate in patients with Afib with RVR often causes these symptoms to improve, again meaning the HR is under 100 with the heart rhythm in afib.

A major indication of atrial fibrillation with RVR is a very rapid heartbeat rate, although some patients are known to have the condition without showing symptoms. Atrial fibrillation with RVR may occur when cardiac muscle cells overcome their intrinsic pacemaker’s signals and fire rapidly differently from their normal pattern spreading the abnormal activity to the ventricles. The rapid heart rate can strain the heart, developing a situation referred to as Tachycardia (meaning a pulse greater than 100). Atrial fibrillation with RVR can be detected from the various symptoms though it is important to remember that some patients have experienced the condition without symptoms.

Always remember the human body is like a car in the following:

The CAR’s heart is the engine! The CAR’s lungs are the transmission! One can’t live without the other or the car will die!  Without these part’s the car won’t start to run if the engine is damaged completely and it won’t be able to allow the car to slow down or speed up via the transmission!

The BODY’s engine is the heart! The BODY’s transmission is the LUNGS.  One can’t live without the other or the body will die!   Without them we will have no air exchange process and the tissues or organs or our body don’t get their food call oxygen and removing the toxic carbon dioxide!

 

 

 

 

 

QUOTE FOR THURSDAY:

“Fibrodysplasia ossificans progressiva is a disorder in which muscle tissue and connective tissue such as tendons and ligaments are gradually replaced by bone (ossified), forming bone outside the skeleton (extra-skeletal or heterotopic bone) that limits movement. This process generally becomes noticeable in early childhood, starting with the neck and shoulders and proceeding down the body and into the limbs.”

QUOTE FOR MONDAY:

“It all comes down to the pathophysiology.  Sepsis ultimately results from a complex interaction of pro-inflammatory, anti-inflammatory, activated complement system, and coagulation mediators that in association with detector and signaling markers, trigger a host response. Initiators (microbes, trauma, hypoxia, ischemia, toxins) cause local tissue damage, which release local pro- and anti-inflammatory markers. Proinflammatory signalers include TNF, IL-1, and IL-6, while anti-inflammatory markers include IL-4, IL-10, IL-11 and soluble TNF receptors. These are designed to function and contain at a local level. If the initiators overwhelm the local response, the mediators affect multiple systems in the body: dermal, cardiovascular, gastrointestinal, renal, neurologic, hematologic/coagulopathic, pulmonary, and endocrine.3,4 All of these mimics have a similar endgame: triggering a systemic reaction that looks just like sepsis.”

emDOCS (http://www.emdocs.net/mimics-of-sepsis/)

Part II Sepsis and SIRS (systemic inflammatory response syndrome)-Still a major problem in hospitals!

Patty Duke and sepsissepsismultihit

               sepsis inflammatory process

Part II talks to you about the multi-hit theory of SIRS with Inflammatory Cascade of SIRS and lastly the coagulation process in SIRS.   It also tells you an extensive amount of infectious and non-infectious causes of SIRS. Lastly the key antidote to SIRS.

Multi-hit theory

A multi hit theory behind the progression of SIRS to organ dysfunction and possibly multiple organ dysfunction syndrome (MODS). In this theory, the event that initiates the SIRS cascade primes the pump. With each additional event, an altered or exaggerated response occurs, leading to progressive illness. The key to preventing the multiple hits is adequate identification of the ETIOLOGY or CAUSE of SIRS and appropriate resuscitation and therapy.

Inflammatory cascade

Trauma, inflammation, or infection leads to the activation of the inflammatory cascade. Initially, a pro-inflammatory activation occurs, but almost immediately thereafter a reactive suppressing anti-inflammatory response occurs. This SIRS usually manifests itself as increased systemic expression of both pro-inflammatory and anti-inflammatory species. When SIRS is mediated by an infectious insult, the inflammatory cascade is often initiated by endotoxin or exotoxin. Tissue macrophages, monocytes, mast cells, platelets, and endothelial cells are able to produce a multitude of cytokines. The cytokines tissue necrosis factor–alpha (TNF-α) and interleukin-1 (IL-1) are released first and initiate several cascades.

The release of certain factors without getting into medical specific terms they ending line induces the production of other pro-inflammatory cytokines, worsening the condition.

Some of these factors are the primary pro-inflammatory mediators. In research it suggests that glucocorticoids may function by inhibit-ing certain factors that have been shown to be released in large quantities within 1 hour of an insult and have both local and systemic effects. In studies they have shown that certain cytokines given individually produce no significant hemodynamic response but that they cause severe lung injury and hypotension. Others responsible for fever and the release of stress hormones (norepinephrine, vasopressin, activation of the renin-angiotensin-aldosterone system).

Other cytokines, stimulate the release of acute-phase reactants such as C-reactive protein (CRP) and pro-calcitonin.

The pro-inflammatory interleukins either function directly on tissue or work via secondary mediators to activate the coagulation cascade and the complement cascade and the release of nitric oxide, platelet-activating factor, prostaglandins, and leukotrienes.

High mobility group box 1 (HMGB1) is a protein present in the cytoplasm and nuclei in a majority of cell types. In response to infection or injury, as is seen with SIRS, HMGB1 is secreted by innate immune cells and/or released passively by damaged cells. Thus, elevated serum and tissue levels of HMGB1 would result from many of the causes of SIRS.

HMGB1 acts as a potent pro-inflammatory cytokine and is involved in delayed endotoxin lethality and sepsis.

Numerous pro-inflammatory polypeptides are found within the complement cascade. It is thought they are felt to contribute directly to the release of additional cytokines and to cause vasodilatation and increasing vascular permeability. Prostaglandins and leukotrienes incite endothelial damage, leading to multi-organ failure.

Polymorphonuclear cells (PMNs) from critically ill patients with SIRS have been shown to be more resistant to activation than PMNs from healthy donors, but, when stimulated, demonstrate an exaggerated micro-bicidal response (agents that kill microbes). This may represent an auto-protective mechanism in which the PMNs in the already inflamed host may avoid excessive inflammation, thus reducing the risk of further host cell injury and death.[4]

Coagulation

The correlation between inflammation and coagulation is critical to understanding the potential progression of SIRS. IL-1 and TNF-α directly affect endothelial surfaces, leading to the expression of tissue factor. Tissue factor initiates the production of thrombin, thereby promoting coagulation, and is a proinflammatory mediator itself. Fibrinolysis is impaired by IL-1 and TNF-α via production of plasminogen activator inhibitor-1. Pro-inflammatory cytokines also disrupt the naturally occurring anti-inflammatory mediators anti-thrombin and activated protein-C (APC).

If unchecked, this coagulation cascade leads to complications of micro-vascular thrombosis, including organ dysfunction. The complement system also plays a role in the coagulation cascade. Infection-related pro-coagulant activity is generally more severe than that produced by trauma.

What the causes of SIRS can be:

The etiology of systemic inflammatory response syndrome (SIRS) is broad and includes infectious and noninfectious conditions, surgical procedures, trauma, medications, and therapies.

The following is partial list of the infectious causes of SIRS:

  • Bacterial sepsis
  • Burn wound infections
  • Candidiasis
  • Cellulitis
  • Cholecystitis
  • Community-acquired pneumonia
  • Diabetic foot infection
  • Erysipelas
  • Infective endocarditis
  • Influenza
  • Intra-abdominal infections (eg, diverticulitis, appendicitis)
  • Gas gangrene
  • Meningitis
  • Nosocomial pneumonia
  • Pseudomembranous colitis
  • Pyelonephritis
  • Septic arthritis
  • Toxic shock syndrome
  • Urinary tract infections (male and female)
  • *The following is a partial list of the noninfectious causes of SIRS:
  • Acute mesenteric ischemia
  • Adrenal insufficiency
  • Autoimmune disorders
  • Burns
  • Chemical aspiration
  • Cirrhosis
  • Cutaneous vasculitis
  • Dehydration
  • Drug reaction
  • Electrical injuries
  • Erythema multiforme
  • Hemorrhagic shock
  • Hematologic malignancy
  • Intestinal perforation
  • Medication side effect (eg, from theophylline)
  • Myocardial infarction
  • Pancreatitis
  • Seizure
  • Substance abuse – Stimulants such as cocaine and amphetamines
  • Surgical procedures
  • Toxic epidermal necrolysis
  • Transfusion reactions
  • Upper gastrointestinal bleeding
  • VasculitisThe treatment is don’t get it since it is hard to get rid of especially for people over 65 and in hospitals.  There is no one Rx for it.  If you’re unfortunate enough to be diagnosed with SIRS the sooner you get diagnosed with it including being in stage one as opposed to three the higher the odds the turn out will be for you.  Again the key is prevention; don’t get it. There is no one antidote to this SIRS

PREVENTION IS THE KEY ANTIDOTE!   So stay healthy and out of  hospitals!