Saturday, August 28, 2010

Great Danes

Gotta love 'em. Gigantic, goofy, stumbling puppies that lick, and bite, and sniff...

I look at a show pup today, hoping for that elusive new job to come about... which I've probably failed to post anything about on here.

Large, global consulting company came calling to have me interview face to face this coming week but have not had that confirmed yet :( Would be awesome and settle a lot of questions in my mind... like, a new great dane puppy.

The puppy was adorable, as all great dane puppies are. However, I want a female dane show pup more than a male... something about having had the most obnoxious, terrorizing, male dane pup 8 years ago when Storm was a tiny bundle of love... and teeth... and paws.

Storm grew into a very well behaved dog, one that garners attention everywhere he goes. People flock to see the awesome fawn boy at my hand, and he is generally off-leash. One murmured "ack" and he immediately corrects himself, looks to me for guidance, and is unshakable. It took years to get him to this point. Not months, but years.

Male great danes, intact, are not for the feint of heart nor for the newly crowned dane owner. With their size, strength, mentality and late blooming teenage years, a male great dane can be difficult to handle... and despite my years upon years of handling danes, I am not up for another intact male.

So, I'll wait for the right female to come along. One that I can call Grace... who will live with Hope, and my beloved Storm.

C'mon consulting company, firm up my dates. I have a dane puppy awaiting me!!! :D

Make it a great dane... oops, I mean great day!

Friday, August 27, 2010

Hmmm...

Organic chemistry - check
Physics - check
Biology - check
Music Theory - check (humanities fulfillment course)

14 cr

Crossing fingers as the itch has gotten much worse... want to be back in school.

Tuesday, August 24, 2010

I've Got An Itch

more like a twitch going on ... textbooks are laid out nicely, my brain is full whirl, courses are still open.

I want to get back to school.

ugh.

How to make it work!?

Monday, August 23, 2010

For You Med School Peeps

Don't submit grant requests to VERY LARGE corporations requesting they pay you for your licensing exams, licensing fees for conferences, or travel related items to said events.

Companies are not allowed to pay you directly.

Hope that helps.

I'm having a fit of giggles right now... got sent a picture too!

hahahahahlolohahahahalolol

Weekend Celebration

Erm. I turned 46 last week whilst handsome boyfriend was on big boat cruising around Italy with his teenager in tow. I might toss in that said man also forgot that his person-of-interest had a birthday. I've never heard such sorrow in a man's voice and hope to never again.

So, we had plans. Dress shopping for the play on Saturday night for which he has had tickets for almost 4 months, dinner before that, and spectacular couples spa day to start the day.

Trouble is, the spa mis-booked our massages. OOPSIE! Then spa mis-booked our facials. OOPSIE x 2!!

Girlfriend - 1
Boyfriend - 2 (he got a massage)

Lunch was fine. Sun started to peek out giving hope for cruise around large local lake on his boat before heading out to play. Who needs dinner when one can nosh on the boat, in the sublime sunshine and warmth that we only get here for about 3 months of the year.

He sat through a pedicure AND a manicure and whilst he sat there very uncomfortably while being pampered, I started to hum Brad Paisley's "I'm Still A Guy" and giggled. I was given the "look" that said he found it entirely amusing. Pamperers were asked what they'd do if boyfriend forgot birthday and both replied, they'd be livid, and quit speaking to him for days.

Wanly, he smiled at me; I giggled and smiled back at him. He's lucky to have me, I figure. I get a point for being patient, understanding, and forgiving.

Boyfriend 0
Girlfriend 1

Rest of the spa day was fine. The spa heavily discounted our day, and gave us a certificate to come back.

Time on the boat was fabulous. He got more details about the Big 4 public accounting firms I'd worked for, and my former employer. It still makes me nervous to tell people about the last four years but honesty is tantamount to building something solid with him.

To finish off the night, we went to Wicked. I saw it four years ago on Broadway and loved it. He has never been.

Dress that I bought on Friday night was a smashing success even garnering comments from people I did not know on the street, inside the venue, and at a restaurant post-play. Thank you to Nordstrom's Maxine for helping me find it, and boyfriend for giving me the thumb's up.

Girlfriend 2
Boyfriend 1

The end of the night was perfect. In barefeet and amazing dress, I taught him how to teach his teenager some basic ground strokes in tennis (I'm a former state champ - not sure he knows that! as he mentioned I'm going to kick his a@@ when we play... haha... payback for that chess match a few months ago... which is a whole other story)

In three years, I've gone from well heeled executive to poor college student trying to make ends meet. I've lost everything, and gained much more.

Honesty has allowed me to face some of the worst days of my life, and let a man into it who is not afraid of the truth.

Honestly, the weekend ended perfectly with me on the winning end.

Girlfriend 4
Boyfriend 3

Honesty. Gotta love it!

Friday, August 20, 2010

For many years, since the death of my own child, I've wanted to be a pediatric oncologist; oncology my field of choice since I was 10. With my son's death, my passion turned to really sick kids, desparately hoping parents, and tiny rays of hope.

There is yet another family enduring the heart breaking finding that their child is very ill. It is heart wrenching. Insidious tumors invading a youngster's brain give no access to surgically remove the invading tissue and therefore, little hope for parents and their beloved child.

I'd encourage the readers to donate to St. Jude. As I do every Christmas, I am asking again.

I may never be the pediatric oncologist I've wanted to be but I can support research institutions like St. Jude, like Johns Hopkins, and indirectly, the parents who find themselves at the mercy of the very talented physicians and researchers.

https://shop.stjude.org/GiftCatalog/express-donation.do?fnl=don_sin&plt=STJGENLKALSAC1000001

And the blog that prompted this post...

http://joshuajoelhunter.blogspot.com/2010/08/what-day.html

Thursday, August 19, 2010

ALS - My Quickly Written Term Paper

Of the hundreds of diagnosed and treated diseases, many are incurable with amyotrophic lateral sclerosis being one of the more horrific. One morning a patient, more than likely a male, between the ages of 45 and 60, wakes up to find his feet numb, hands tingling, with a twitch in the eyes or tremors in the hands, and perhaps, trouble swallowing.

Those symptoms reflective of motor neuron death or degeneration, are investigated by a physician via family history interview, nerve testing, MRI, and other neural imaging devices. Because there is no specific laboratory test for ALS, by eliminating other potential diseases such as muscular dystrophy or multiple sclerosis, those diseases which likewise affect the motor skills and nervous system, a diagnosis of amyotrophic lateral sclerosis can be made. ALS, or Lou Gehrig's disease, is defined as a motor neuron disease and specifically affects the upper motor neurons contained in the brainstem and cerebral cortex, and the lower motor neurons contained in the spinal cord. Both must be present in order for ALS diagnosis (Figure 1).

Sadly, as the disease progresses it does not decrease the intellectual capacity of the individual enabling the patient to be fully cognizant of their decreasing physical capacity leading quite often to severe depression. Simple movements such as turning over during sleep, or picking up a fork, or turning the head to look at something is impossible. The unable body cannot react to the very able mind.

From the point of first acknowledged symptom to death, the average life expectancy is between three and five years for there is no cure and treatments available are not substantially life prolonging, only quality enhancing and symptom reducing.

ALS was first defined and diagnosed by a Jean-Marie Charcot, a neurologist, in 1874. For almost 140 years since that definition, no specific cause has been found although many theories exist and are being investigated. Because the disease affects humanity with almost complete randomness, one theory that has caught the attention of scientists involves chromosome 21 and the gene encoding for the enzyme, superoxide dismutase, SOD1.

In normal functioning SOD1, the protein takes reactive oxygen and converts it into water. However, in ALS, missense mutations of the gene have been noted to cause about 50% of the familial cases of ALS which amounts to roughly 2.5% of the patients today. These gene mutations cause misfolding of the protein SOD1 which gave scientists the first clue given that protein shape determines function. Researchers investigating the folding of the protein found that deposits built and either caught other proteins necessary for cell health from getting to their destination, or built up to a toxic level eventually leading to cell death (apoptosis). The apoptosis of these specific cells along the neural pathways, causes a demyelination of the nerve (Figure 2).

In June 2009, researchers found that faster clumping of the protein led to faster progression of the disease leading them to hypothesize that the SOD1 mutation is missed during a cell's normal "house cleaning" activity.(15) Evidence is accumulating that glutamate is aggregated amongst the SOD1 protein and causing toxicity.(16) This finding would allow researchers to target drugs at intercepting this aggregation and stop the progression of the disease.(17) The continued hope is that finding a treatment for the familial ALS will help direct treatment for the other patients as well. (18)

The worldwide estimated ALS incidence level is .0024% or 2.4 people per 100,000.(19) The disease has no definitive boundaries related to geography, overall health, diet, race, climate, or socio-economic factors.(20) Common characteristics of the disease as it progresses include trouble with: dysphagia (swallowing), dysarthiria (speaking), spasticity (tight and stiff muscles), hyperreflexia (over excited reflexes including Babinski's sign), and fasciculation (muscle twitching).(21) In addition, loss of muscle tone leads to constipation, lack of normal functioning ability leads to fatigue and depression.(22) Muscle tone also affects the individual's ability to breathe and eventually, in most cases, respiratory failure due to the inability of the muscles to aid breathing, or choking on food, is what leads to death.(23)

While no known causation is seen between various life factors, economic factors could dictate how much palliative care assistance an individual is able to obtain. As of 2009, the only drug approved for treatment of ALS by the FDA is Riluzole which has been shown to block the release of glutamate.(24) At a cost of approximately $10,000 a year with a limited increase in life of 2 months, other economic concerns include: motorized wheel chairs, electronic lifts for motorized vehicles, depression medications, and eventually, hospice or palliative care professionals.(25) Many families are not equipped financially to pay for the additional costs which also leads to depression among family and friends.(26)

The impact of ALS on the individual notwithstanding, the disease greatly affects the primary care giver, family, physicians who treat the individual, and friends. Difficult to watch, harder to grasp the deteriorating condition of a loved one is painful. ALS is insidious as it robs the person of their physical ability to interact with others normally; the patient's mind fully comprehending the fatality of the disease.

CREDIT TO WHERE CREDIT IS DUE! 
http://www.ninds.nih.gov/disorders/amyotrophiclateralsclerosis (1-7, 9, 14-18, 20-23)

http://www.als-mda.org/publications/images/Motor-Neuron.jpg (Figure 1)

http://dev.nsta.org/evwebs/2150/history.htm (8)

Gerard Dynes, Christopher Schwimmer, Susan Staugaitis, John Doyle, Arthur Hays, Hiroshi Mitsumoto (2000, November 13). Amyotrophic lateral sclerosis with multiple sclerosis: A clinical and pathological report. Retrieved from http://www.PubMed.gov (19)

http://faculty.washington.edu/alexbert/MEDEX/Fall/AmyotrophicLateralSclerosis.jpg (Figure 2)

Kumar, Vinay, Hogge, Alice & Baer, Arthur (2007). Robbins Basic Pathology - 8th Ed. Philadelphia. (10 - 13)

Miller RG, Mitchell, JD, Lyon M, and Moore DH (April 2003). Riluzole for amyotrophic lateral sclerosis (ALS)/motor neuron disease (MND). Neurology. Retrieved from

http://www.PubMed.gov (24-26)

Wednesday, August 18, 2010

ALS - Did Lou Really Have It

A report has surfaced that Lou Gehrig, the face of Amyotrophic Lateral Sclerosis, might have had a different motor neuron issue, and not the dreaded ALS afterall.

Autopsies performed on three athletes who were similarly diagnosed with ALS showed that the indicators of neuronal death did not occur. While symptomatically the patients had ALS, histologically, they did not.

Whether or not the patients did or did not have ALS is irrelevant to my post. I'm not a PhD researcher or M.D. (yet) but what catches my mind is this:

If it were able to be shown that Lou Gehrig did not in fact have the disease, would that lessen the interest in trying to find a cure for it?

Currently, having a big name attached to a fatal diagnosis has helped create awareness and interest in curing it. Thankfully, in my opinion, the Mayo Clinic has stated that it will not release the medical records of Gehrig since he is not able to sign, and left no heirs able to sign a medical release for him. Likewise, he is not able to be exhumed and autopsy performed because he was cremated.

ALS is an incidious neuronal pestilence for which I pray research continues at full steam. Robbing the body of its ability to move, the mind stays intact and fully coherent, cognizant of everything that occurs.

The article that prompted the post is here:

http://www.startribune.com/lifestyle/health/100950649.html?elr=KArksLckD8EQDUoaEyqyP4O:DW3ckUiD3aPc:_Yyc:aULPQL7PQLanchO7DiUsr

Tuesday, August 17, 2010

Today is...

my 46th birthday. That sounds really old. I even got a membership to AARP. That makes me feel really old.

Blech.

Make yours a great day and I shall try to salvage something from today :)

Edited

Started off the day with an email from very handsome boyfriend cruising around the Mediterranean with his teenager. Pretty excited to open it only to read, "Have a nice day." Sure, there was a little more to it than that but obviously, handsome man on big boat in Italy forgot something. The day his lovely was born!

I was hurt. Really hurt. I don't expect much, perhaps that is why I don't get much either but a simple, "Happy Birthday" at the end of that email would have done wonders. Put a smile on my face, a skip in my step, started my day off on right (or left) foot.

I dunno. Anything? Something?

By noon, I realized he'd completely forgotten. My hurt was deepening. Seriously, this is the man I'm planning a myriad of events for, spending whatever spare time either of us has, and he forgets?

By three, I'd returned my new dress for the celebration this weekend and was thinking of the way I could extricate myself from the relationship. There have been other tiny red flags but this was putting the nail in the coffin. Can we say I was pouting?!?!?

About 3:15 my phone lights up, it is none other than Sir Hawtsalot (you cannot take that name for your own beau, it's alllllll mine). He apologized profusely. And then made my day.

NOT by wishing me a Happy Birthday, NOT by saying he was profusely sorry, NOT by saying he'd make it up to me.

Sir Hawtsalot made my day by telling me the truth and by telling me this:

My son, who has never met this man or even talked to him, saw the hurt on my face and reached out to Sir H letting him know that I was a year older.

It was my son with a not-so-gentle reminder that today is my birthday and Sir Hawtsalot would be well advised to email or call.

THAT made my day. I'm blessed. With both of those men in my life... I adore them both!

Sunday, August 15, 2010

How Things Have Changed

Anger is a normal, human emotion. Everyone feels it. Everyone reacts to it. How one reacts to that passionate dissonance inside is one aspect of what defines us to the outside world.

Take my neighbors this morning for instance.

Calmly drinking my diet coke, eating my chocolate covered donut, pondering my day's event (dress shopping for very fun activity next weekend with very handsome man who is not-my-son), I hear as loud as day;

She, "So get your A@@ over here and help me, you moth...f...in jerk. All you do is sit around, drink beer, and swear at me. Can't you help?"

He, "You're such a bi#$%. If maybe you'd stop to think about how stupid you sound to the rest of the world and quit your dumb as bat-sh@# swearing at me like you're some bad@#$ Harley ho, maybe I'd be more helpful. Je@#$ you sound like a sailor!"

And so it went. For about 10 minutes, 100' away from my front door, 100' separating them from each other, it continued.

The swearing got worse, of course, the name calling, gender bending antics of my neighbors in a neighborhood that I long to leave quickly and as quietly as I came.

Last year, I was sitting upon my deck at night relishing the quiet stillness of the surrounding forest, taking pictures of the meandering fawns and does that sniffed and wove their way into my yard. The worst I ever heard from my neighbors was a car door slammed, or maybe a loud boisterous laugh at a bonfire...

Those were the days. I eagerly await those days coming back to me.

Soon, I suppose. Until then, I shall giggle at the loud, swearing boisterous couple inside the respite of my rented house.

Make yours a great day and I shall do the same!

Saturday, August 14, 2010

Physics Help

Courtesy of a fellow blogger and traverser to and through med school.

http://medschoolodyssey.wordpress.com/2010/08/07/168/

I found physics completely entertaining. Changed the whole way I view the world, the working and changing components from how force works when I walk to how a car drives forward, to angles when projectiles are launched off a cliff, to everything.

I credit my exhuberence to a great professor.

Friday, August 13, 2010

Well, This Was A Whirlwind

My mom was readmitted for surgery, this time they were looking at more stones, and also checking her heart (not during surgery).

Dad is getting weaker and more tired.

Storm has the zoooooomies.

On Monday, I have a meeting with my former university to see about refund of last fall's tuition given all that I've detailed here before. Given the 3" binder I have full of emails, text messages, inappropriate other things, I'm hopeful they will not only refund my tuition but wipe my transcript of the "W"s. If that happens, I'm registering for organic, biology, physics, and probably some humanites type class in music theory or American Indian studies.

Yes, you read that right. IF it works out with the university, I'm continuing on!

Also, I have an awesome contract opportunity for me elsewhere. The medical device company has been thoroughly enjoyable as I've learned so much about technology but also grant process, how egotistical some people can be, how to effectively tell them "No", had the opportunity to meet the president of my division because of one such doc and the president supported my decision (note to doc: former VP of internal audit is no slouch and no doormat, perhaps had said doctor KINDLY requested a review and reassessment, I might have been more amenable to adjusting my grant amount).

Anyway, wish me luck. I'm so hopeful... and so eager to get back at it!!!

Thursday, August 5, 2010

Endoscopy - Yuck?

Mom's recovery is not going very well. She ended up in the emergency room yet again with sharp pains, sick/quesy feeling, and exhausted.



The endoscopic exam is this morning and my hope is that they find nothing wrong. The larger fear, however, is that there are more stones that were missed during initial surgery.



Patient care starts with the surgery but has to include the follow-up care as well.



With her knee replacement the surgeon never saw her again, never placed rehab on her charts, and never requested follow up visits. Maybe that's how it is in small rural clinics but something tells me, I'd rather keep track of my patients and how their recovery after surgery is tracking. Otherwise, why not just practice in large metro where a patient is a number and as long as the bill gets paid, no one really cares?



I know - that's a harsh statement about metro clinics. Metro clinics offer features the rural clinics cannot, namely more technology to make quicker and more accurate diagnoses, more personnel with whom to discuss patient issues and diagnoses, better ability to refer more often than not

Monday, August 2, 2010

Much Ado About Nada

Hope all of you are well!

Just really swamped at the moment, trying to invigorate a career once thought dead. Have had some hits on my interest level in certain consulting jobs, current contract employer is looking for me as well - they have great tuition reimbursement plans... just not sure they want to send a compliance auditor to med school :)

The elderly couple's situation is being monitored. It is likely they will be reimbursed in full for what they lost as the good banker kept track of what was in the jug - not by coin serial number but by date and amount.

Mom is recovering although not quite as quickly as I'd like her to. She's learning to eat less and keep her weight down which should help alleviate the pain in her hips as well as her glucose levels.

Life is stabilizing for me. If one of the jobs come through, I'll be registered shortly for fall semester... and the drum beat continues.

Make it a great day!