Phuck Fibromyalgia

I suffer from fibromyalgia. I have a fairly mild case, but sometimes it gets the better of me. I can no longer do heavy physical activity, which is why even though I'm a licensed EMT I don't work on an ambulance. I have also suffered from several lower back injuries and this pain is exacerbated by the fibromyalgia.
There are days when I'm fairly well asymptomatic, especially since I switched to working in a department where the physical demands are far less. Chiropractic treatments tend to help as realigning the muscles and spine means less stress on the muscles and joints. (The type of chiropractic I receive involves manipulation of the muscles which leads to eventual reposition of the vertebrae as opposed to "cracking" the bones. It's far more effective in the long term.) However if I overdo things, whether physically or simply through being under too much stress, my muscles start to ache. Often it radiates down my arms, so that even if I haven't been doing any heavy lifting they feel like I've overdone things at the gym. Currently the pain is mostly in my lower back and my ankles, although there is some pain all over. I consider myself fortunate that I'm not one of those people that has such bad fibromyalgia that I can't bear to be touched. However, experiencing pain all over the body tends to exacerbate the fatigue that I'm already experiencing, and it becomes a vicious cycle. Due to suffering from bipolar disorder as well, the fatigue and resulting frustration can trigger a depressive spiral.
I wonder how closely problems like chronic fatigue or fibromyalgia are tied in with mood disorders.
Here are some basic Fibromyalgia facts:
Fibromyalgia (FM or FMS) is a debilitating chronic syndrome (constellation of signs and symptoms) characterized by diffuse or specific muscle, joint, or bone pain, fatigue, and a wide range of other symptoms. It is not contagious. It affects more females than males, with a ratio of 9:1 by ACR (American College of Rheumatology) criteria[2]. Fibromyalgia is seen in 3% to 6% of the general population, and is most commonly diagnosed in individuals between the ages of 20 and 50. The nature of fibromyalgia is not well understood. There are few, if any, treatments available[3], and there is no cure, but the disease is not life-threatening.
The primary symptom of fibromyalgia is widespread, diffuse pain, often including heightened sensitivity of the skin (Allodynia), tingling of the skin (often needlelike), achiness in the muscle tissues, weakness in the limbs, and nerve pain. Chronic sleep disturbances are also characteristic of fibromyalgia, and some studies suggest that these sleep disturbances are the result of a sleep disorder called alpha wave interrupted sleep pattern, a condition in which deep sleep is frequently interrupted by bursts of brain activity similar to wakefulness.

Many patients experience "brain fog", also known as "fibrofog", which is objectively proven abnormally slow brain waves and objectively proven cognitive deficits[5]. Many experts suspect that "brain fog" is directly related to the sleep disturbances experienced by sufferers of fibromyalgia.

Other symptoms often attributed to fibromyalgia (possibly due to another comorbid disorder) are chronic paresthesia, physical fatigue, irritable bowel syndrome, genitourinary symptoms such as those associated with the chronic bladder condition interstitial cystitis, dermatological disorders, headaches, myoclonic twitches, and symptomatic hypoglycemia. Although it is common in people with fibromyalgia for pain to be widespread, it may also be localized in areas such as the shoulders, neck, back, hips, or other areas. Not all patients have all symptoms.

Fibromyalgia can start as a result of some trauma (such as a traffic accident) or illness, but there is currently no known strong correlation between any specific type of trigger and the subsequent initiation of fibromyalgia. Symptoms can have a slow onset, and many patients have mild symptoms beginning in childhood, such as growing pains. Symptoms are often aggravated by unrelated illness or changes in the weather. They can become more tolerable or less tolerable throughout daily or yearly cycles; however, many people with fibromyalgia find that, at least some of the time, the condition prevents them from performing normal activities such as driving a car or walking up stairs. The syndrome does not cause inflammation as is presented in arthritis, but anti-inflammatory treatments, such as Ibuprofen and Iontophoresis, are known to temporarily reduce pain symptoms.

Variability of Symptoms
The following factors are said to temporarily increase the suffering of patients:
Cold weather, especially when damp
Malnutrition, hunger, or starvation
Physical activity of any kind, including minor tasks such as writing
Lack of deep sleep
Increase of stress
The consumption of alcohol
Some patients have reported a near-complete remission of their symptoms within several weeks of traveling to a warm, or tropical climate, especially with rest and relaxation, and the complete renewal of symptoms upon returning.

Diagnosis
When making a diagnosis of fibromyalgia, a practitioner would take into consideration the patient's case history and the exclusion of other conditions such as endocrine disorders, arthritis, and polymyalgia rheumatica. There are also two criteria established by the American College of Rheumatology for diagnosis:
A history of widespread pain lasting more than three months — widespread as in all four quadrants of the body, i.e., both sides, and above and below the waist.
Tender points — there are 18 designated possible tender points (although a person with the syndrome may feel pain in other areas as well). During diagnosis, four kilograms-force (40 Newtons) of force[3] is exerted at each of the 18 points; the patient must feel pain at 11 or more of these points for fibromyalgia to be considered. Four kilograms of force is about the amount of pressure required to turn fingernails white or to feel pain sensations on the forehead. This technique was developed by the American College of Rheumatology as a means of confirming the diagnosis for clinical studies. It is also used in the United Kingdom. Pressure on nearby areas rarely elicits any reaction. Fibromyalgia patients also have elevated levels of Substance P in the body, which increases the levels of pain and intensity.

Differentials
A number of other disorders can produce essentially the same symptoms as fibromyalgia. Other disorders known to produce similar symptoms are:
Myofascial pain syndrome
Chronic fatigue syndrome
Tendinitis
Gulf War syndrome
Depression
Influenza
Thyroid disease
Vitamin B12 deficiency
Lyme disease
Celiac disease
Mercury toxicity
Lead poisoning
Lupus erythematosus (SLE)
Whiplash-associated disorder

Treatment
As with many other soft tissue and rheumatolgical organic disorders, there is no cure for fibromyalgia, but some treatment options are available. A patient may try many routes of treatment under the guidance of a physician to find relief. Treatments range from symptomatic prescription medication to alternative and complementary medicine.

One experimental treatment is the use of the Guaifenesin Protocol, developed by Dr. R. Paul St. Amand. Because of the large number of patients improving on Guaifenesin, there are now several doctors throughout the U.S. who are using the Guaifenesin protocol in their practices[6].

Conventional analgesics rarely reduce the pain, and even strong narcotics are often not sufficient to entirely eliminate the pain.

Low doses of antidepressants like amitriptyline and trazodone may be used to reduce the sleep disturbances sometimes associated with fibromyalgia and are believed by some practitioners to help correct sleep problems that may exacerbate the symptoms of the condition. Because depression often accompanies chronic illness, these antidepressants have additional psychological benefits for patients suffering from depression. Amitriptyline is often favoured as it can also have the effect of providing relief from neuralgenic or neuropathic pain. Some doctors advise against using narcotic sleep aids ("hypnotics"), since these can actually disrupt deep sleep.

New drugs showing significant efficacy on fibromyalgia pain and other symptoms include milnacipran, gabapentin, meloxicam and possibly pregabalin. Milnacipran belongs to a new series of drugs known as serotonin-norepinephrine reuptake inhibitors (SNRIs), and is currently available in parts of Europe where it has been safely prescribed for other disorders. As of August 2005, Milnacipran is the subject of a Phase III study, and, if ultimately approved by the FDA, will be distributed in the United States.

Muscle relaxants such as Cyclobenzaprine (Flexeril) and Orphenadrine Citrate (Norflex) have also been studied in the treatment of fibromyalgia. Cyclobenzaprine has a tricyclic chemical structure similar to Amitriptyline, yet its anti-depressant effects are minimal. It is used only as a short-term muscle relaxant. In a study of 120 fibromyalgia patients, those receiving Cyclobenzaprine (10 to 40 mg) over a 12 week period had significantly improved quality of sleep and pain score. There was a trend towards improvement in fatigue symptoms but not in duration of morning stiffness. Interestingly, there was also a reduction in the total number of tender points and muscle tightness.

Studies have found gentle exercise, such as warm-water pool therapy, improves fitness and sleep and may reduce pain and fatigue in people with fibromyalgia. Stretching is recommended to allay muscle stiffness and fatigue, as is mild aerobic exercise. Because strenuous activity can exacerbate the muscle pain and fatigue already present, patients are advised to begin slowly and build their activity level gradually to avoid inducing additional pain. Exercise may be poorly tolerated in more severe cases with abnormal post-exertional fatigue.

Cognitive behavioral therapy has been shown to improve quality of life and coping in fibromyalgia patients and other sufferers of chronic pain.

EEG Biofeedback has also shown to provide temporary and long term relief, and as it gains more widespread coverage.

Many patients find temporary relief by applying heat to painful areas. Those with access to physical therapy and/or massage may find them beneficial. Chiropractic care can also help relieve pain due to fibromyalgia.

Treatment for the "brain fog" has not yet been developed, however biofeedback and self-management techniques such as pacing and stress management may be helpful for some patients.

A number of practitioners are attracted to the treatment of fibromyalgia, especially because its cause has yet to be identified, and due to its permanent nature, ongoing treatments can be very profitable. While this interest may promote legitimate medical research, patients should be wary: treatments of dubious validity exist in the meantime.

Living with fibromyalgia
Fibromyalgia can affect every aspect of a person's life. While neither degenerative nor fatal, the chronic pain associated with fibromyalgia is pervasive and persistent. FMS can severely curtail social activity and recreation, and as many as 30% of those diagnosed with fibromyalgia are unable to maintain full-time employment. Like others with disabilities, individuals with FMS often need accommodations to fully participate in their education or remain active in their careers.

In the United States, those who are unable to maintain a full-time job due to the condition may apply for Social Security Disability benefits. Although fibromyalgia has been recognized as a condition, along with chronic fatigue syndrome, by the government, applicants are often denied benefits. However, most are awarded benefits at the state judicial level; the entire process often takes two to four years.

In the United Kingdom, the Department for Work and Pensions recognizes fibromyalgia as a condition for the purpose of claiming benefits and assistance[7].

In India, the position with reference to this condition is unclear. However, where the person is rendered incapable of maintaining a regular life due to any disability, he/she can claim disability benefits. Indian laws guarantee that discrimination against people with disabilities is a violation of their individual rights.

Fibromyalgia is often referred to as an "invisible" illness or disability due to the fact that generally there are no outward indications of the illness or its resulting disabilities. The invisible nature of the illness, as well as its relative rarity and the lack of understanding about its pathology, often has psychosocial complications for those that have the syndrome. Individuals suffering from invisible illnesses in general often face disbelief or accusations of malingering or laziness from others that are unfamiliar with the syndrome.

There are a variety of support groups on the Web that cater to fibromyalgia sufferers. Some are offered at the bottom of this article.

Theories on the cause of fibromyalgia
The cause of fibromyalgia is currently unknown. Over the past few decades, many theories have been presented, and the understanding of the disorder has changed dramatically. Most current theories explain only a few symptoms of the disorder and are thus incomplete.

Sleep disturbance
The sleep disturbance theory postulates that fibromyalgia is related to sleep quality. Electroencephalography (EEG) studies have shown that people with fibromyalgia lose deep sleep[8]. Circumstances that interfere with "stage 4" deep sleep (such as drug use, pain, or anxiety) appear to be able to cause or worsen the condition.

According to the sleep disturbance theory, an event such as a trauma or illness causes sleep disturbance and, possibly, some sort of initial chronic pain. These initiate the disorder. The theory supposes that "stage 4" sleep is critical to the function of the nervous system, as it is during that stage that certain neurochemical processes in the body reset. In particular, pain causes the release of the neuropeptide substance P in the spinal cord, and substance P has the effect of amplifying pain and causing nerves near the initiating ones to become more sensitive to pain. Under normal circumstances, this just causes the area around a wound to become more sensitive to pain, but, if pain becomes chronic and body-wide, then this process can run out of control. The sleep disturbance theory holds that deep sleep is critical in order to reset the substance P mechanism and prevent this out-of-control effect.

An interesting aspect of the sleep disturbance/substance P theory is that it explains "tender points" that are characteristic of fibromyalgia but which are otherwise enigmatic, since their positions don't correspond to any particular set of nerve junctions or other obvious body structures. The theory posits that these locations are more sensitive because the sensory nerves that serve them are positioned in the spinal cord to be most strongly affected by substance P. The theory also explains some of more general neurological features of fibromyalgia, since substance P is active in many other areas of the nervous system.

Critics of the theory argue that it does not explain slow-onset fibromyalgia, fibromyalgia present without tender points, or patients without heightened pain symptoms, and a number of the non-pain symptoms present in the disorder.

Also of interest is a possible connection between this theory and the theory that chronic fatigue syndrome and post-polio syndrome are due, at least in part to damage to the ascending reticular activating system of the reticular formation. This area of the brain, in addition to apparently controlling the sensation of fatigue, is known to control sleep behaviors and is also believed to produce some neuropeptides, and thus injury or imbalance in this area could cause both CFS and sleep-related fibromyalgia, explaining why the two disorders so often occur together.

Deposition disease
Another theory involves phosphate and calcium accumulation in cells that eventually reaches a level to impede the ATP process, possibly caused by a kidney defect or missing enzyme that prevents the removal of excess phosphates from the blood stream. This theory posits that fibromyalgia is an inherited disorder, and that phosphate buildup in cells is gradual (but can be accelerated by trauma or illness). Calcium is required for the excess phosphate to enter the cells. The additional phosphate slows down the ATP process; however the excess calcium prods the cell to continue producing ATP[9].

Diagnosis is made with a specialized technique called mapping, a gentle palpitation of the muscles to detect lumps and areas of spasm that are thought to be caused by an excess of calcium in the cytosol of the cells. This mapping approach is specific to deposition theory, and is not related to the trigger points of myofascial pain syndrome.

While this theory does not identify the causative mechanism in the kidneys, it proposes a treatment known as guaifenesin therapy. This treatment involves administering the drug guaifenesin to a patient's individual dosage, avoiding salicylic acid in medications or on the skin, and, if the patient is also hypoglyemic, a diet designed to keep insulin levels low.

The phosphate build-up theory explains many of the symptoms present in fibromyalgia and proposes an underlying cause. The guaifenesin treatment, based on this theory, has received mixed reviews, with some practitioners claiming many near-universal success and others reporting no success. Only one controlled clinical trial has been conducted to date, and it showed no evidence of the efficacy of this treatment protocol. This study was criticized for not limiting the salicylic acid exposure in patients, and for studying the effectiveness of only guaifenesin, not the entire treatment method. As of 2005, further studies to test the protocol's effectiveness are in the planning stages, with funding for independent studies largely collected from groups which advocate the theory.

Fibromyalgia as severe TMS
Another theory is that fibromyalgia is a severe form of Tension myositis syndrome (TMS) which is a mindbody disorder popularized in the books on healing back, neck, and other limb pain by Dr. John E. Sarno of the Howard A. Rusk Institute of Rehabilitation Medicine. Briefly the theory is that in many cases chronic pain is the result of physical changes (primarily mild oxygen deprivation) caused by the brain through the autonomic nervous system as a strategy for distracting you from painful or dangerous unconscious emotions such as repressed anger. Treatment is through a program of education and attitude change which stops the brain from using that chronic pain strategy. Psychotherapy is suggested in the minority of cases where education alone is not sufficient.

Other theories
Other theories relate to various toxins from the patient's environment, viral causes such as the Epstein-Barr Virus, growth hormone deficiencies, an aberrant immune response to intestinal bacteria,[10][11] neurotransmitter disruptions in the central nervous system, and erosion of the protective chemical coating around sensory nerves. Due to the multi-systemic nature of illnesses such as fibromyalgia and chronic fatigue syndrome (CFS/ME), an emerging branch of medical science called psychoneuroimmunology (PNI) is looking into how the various theories fit together.

Comorbid diseases
Cutting across several of the above theories is a theory that proposes that fibromyalgia is almost always a comorbid disorder, occurring in combination with some other disorder that likely served to "trigger" the fibromyalgia in the first place. This concept fits especially well with the sleep disturbance theory.

By this theory, some other disorder (or trauma) occurs first, and fibromyalgia follows as a result. In some cases, the original disorder abates on its own or is separately treated and cured, but the fibromyalgia remains. In other cases the two disorders coexist. This theory would explain why such a wide variety of symptoms are often ascribed to fibromyalgia, since there are potentially a wide variety of comorbid disorders. It also helps explain why fibromyalgia is so hard to treat, since the fibromyalgia is unlikely to abate while the comorbid condition is untreated.

Commonly proposed comorbid/trigger disorders are:

Spinal disorders
Physical trauma, as from a traffic accident
Post-surgical pain
Chronic fatigue syndrome
Irritable Bowel Syndrome
Myofascial Pain Syndrome
Thyroid disease - for example Hashimoto's thyroiditis; thyroid hormone substitution can be helpful in some cases
Lyme disease
Post-polio syndrome
Hypermobility (including Ehlers-Danlos syndrome)
Restless Leg Syndrome
Clinical depression
Lupus erythematosus (SLE)

Skepticism
Some physicians believe that fibromyalgia is not an actual symptom complex. They claim that the symptoms of fibromyalgia are manifestations of depression, along with symptoms of unrelated diseases such as chronic fatigue syndrome, Epstein-Barr syndrome, interstitial cystitis, irritable bowel syndrome, bacterial infection, and others.

Skeptics point to the following list - some of which is no longer true - to support their skeptical positions:

lack of objective evidence to support patient's claims of suffering (no longer true)
divergent or unrelated symptoms ("syndrome")
the different rates of illness among members of different cultures
a relative lack of evidence-based treatments
a correspondingly large number of "quack" healers providing unproven, incorrect, or ineffective diagnosis and treatment
Some medical authorities who are unaware of the current objective physiological indicators revealed by recent research (such as substance P abnormalities) still believe that depression and psychological factors are the root cause of the syndrome, similar to hypochondria[4][5], despite the fact that as of 2006, there are no known specialist fibromyalgia researchers who agree.

"This isn't a disease, it's merely a description of symptoms... We've taken stress, psychosocial distress and pain and the ordinary life experiences some people have and turned them into something they're not -- a physical illness"
-- Dr. Fred Wolfe, a skeptical Rheumatologist who ironically helped define the disease earlier in his career[12].
However, depression should be expected to accompany any debilitating illness. In other words, depression is not a special trait of fibromyalgia. Interestingly, many victims of fibromyalgia either do not suffer from depression at all, or they did not suffer from it until after its onset.

References
^ Information from the National Fibromyalgia Association
^ Fibromyalgia from WebMD
^ [1] Cough syrup found by University of Florida to reduce fibromaylgia pain "moderately" but not recommended for personal self treatment
^ Fibromyalgia, published by BUPA insurance
^ Fibrofog, Fibromyalgia and Dissociation
^ Recommended Guaifenesin protocol practitioners
^ The Fibromyalgia Association of the UK
^ [2]
^ Are phosphates the hidden enemy? (76.7kb pdf)
^ Kendall SN (May 2004). "Remission of rosacea induced by reduction of gut transit time.". Clin Exp dermatol. 29 (3): 297-9. PMID 15115515.
^ Pimental M, Wallace D, Hallegua D et .al (April 2004). "A link between irritable bowel syndrome and fibromyalgia may be related to findings on lactulose breath testing.". Ann Rheum Dis. 63 (4): 450-2. PMID 15020342.
^ Article from Immune Support
Retrieved from "http://en.wikipedia.org/wiki/Fibromyalgia"

Missing Body Parts

Click the title link. Fun for medical personnel and other sick fucks!

Stem Cell Research

Click the title link. I really need to do more research on this topic myself. As it stands I don't feel qualified to comment. But I'm very interested in learning more.

Online Histology Slides

Study microscopic images of various tissues by clicking the title link!

The Third Degree

Here is a copy of my most recent assignment for my Anatomy and Physiology class. The text is entirely mine. If anyone wishes to quote from it or use the information for their own assignment, or to use the entire essay for teaching purposes, feel free.

COMPLICATIONS AND TREATMENT OF THIRD DEGREE BURNS
The severity of the potential complications posed by third degree burns depends on which part of the body was burned and on the amount of tissue that was damaged. The percentage of damage is calculated using the Rule of Nines. The following is the Rule of Nines measures for an adult: each arm has 9% of the body’s total skin, the head 9%, each leg 18% (two 9’s), the front of the torso 18%, the back of the torso 18%, and the neck 1%. Generally speaking, as the percent of the surface burned increases, morbidity and the probability of mortality increases sharply. Burns which cover 20% or more of the body surface can be fatal without treatment.
The most urgent complication posed by third degree burns is death due to loss of blood plasma, leading to circulatory shock and cardiac arrest. This happens because of fluid being transferred from the bloodstream to replace the fluid lost from the damaged tissue. The result is a decrease in the volume of circulating bloodstream. Another pressing complication comes from the potential for infection in the burned, dead tissue known as eschar. A secondary concern is contracture, or abnormal connective tissue fibrosis as the result of a third degree burn being left to heal on its own without medical intervention. Severe deformities can result from this.
Treatment for third degree burn victims starts with administering intravenous fluid to replace that which has been lost from the damaged tissue. The burn victim must also consume a very high number of calories to make up for protein loss and assist in tissue repair. They will receive supplemental nutrition intravenously or through a gastric tube. They will also receive powerful antibiotics.
The patient is kept in a sterile environment and will receive debridement treatments. The most commonly used method for many years has been mechanical debridement, in which a moist dressing is applied then manually removed. This can be excruciatingly painful for the patient. However, there have been advances in burn treatment and alternative types of debridement such as autolytic debridement are being used in certain cases. Autolytic debridement uses occlusive or semi-occlusive dressings to maintain wound fluid contact with the necrotic tissue. This encourages the body's enzymes and fluids to re-hydrate, soften and finally liquefy hard eschar and slough. Only necrotic tissue is liquefied. This debridement method is virtually painless for the patient but cannot be used in all cases.
After the initial treatment, the patient is likely to require a skin graft. Doctors generally perform an autograft, where skin is taken from another location on the person’s own body, usually the thigh or buttock, and is grafted to the burned area. However, in patients with more extensive burns, surgeons will use an isograft which employs skin from the patient’s close relative, preferably an identical twin. Skin banks also provide skin from cadavers to utilize in homografts. The rejection percentage for homografts is high. Surgeons generally use this measure as a temporary covering for the burned area until the patient is healthy enough to undergo an autograft. Pig skin can also be used in the same way. This method is known as a xenograft. Scientists are also working on developing artificial skin which will provide great advancement in the field of reconstructive treatment for burn patients.
C. Hartley
July 11, 2006

The following text is copied from this website which I utilized in part of my research:
http://www.medicaledu.com/debridhp.htm
Types of Wound Debridement
Autolytic Debridement:
Description:
Autolysis uses the body's own enzymes and moisture to re-hydrate, soften and finally liquefy hard eschar and slough. Autolytic debridement is selective; only necrotic tissue is liquefied. It is also virtually painless for the patient. Autolytic debridement can be achieved with the use of occlusive or semi-occlusive dressings which maintain wound fluid in contact with the necrotic tissue. Autolytic debridement can be achieved with hydrocolloids, hydrogels and transparent films.
Best Uses:
In stage III or IV wounds with light to moderate exudate
Advantages:
Very selective, with no damage to surrounding skin.
The process is safe, using the body's own defense mechanisms to clean the wound of necrotic debris.
Effective, versatile and easy to perform
Little to no pain for the patient
Disadvantages:
Not as rapid as surgical debridement
Wound must be monitored closely for signs of infection
May promote anaerobic growth if an occlusive hydrocolloid is used

Enzymatic Debridement:
Description:
Chemical enzymes are fast acting products that produce slough of necrotic tissue. Some enzymatic debriders are selective, while some are not.
Best Uses:
On any wound with a large amount of necrotic debris.
Eschar formation
Advantages:
Fast acting
Minimal or no damage to healthy tissue with proper application.
Disadvantages:
Expensive
Requires a prescription
Application must be performed carefully only to the necrotic tissue.
May require a specific secondary dressing
Inflammation or discomfort may occur

Mechanical Debridement:
Description:
This technique has been used for decades in wound care. Allowing a dressing to proceed from moist to wet, then manually removing the dressing causes a form of non-selective debridement.
Hydrotherapy is also a type of mechanical debridement. It's benefits vs. risks are of issue.
Best Uses:
Wounds with moderate amounts of necrotic debris
Advantages:
Cost of the actual material (ie. gauze) is low
Disadvantages:
Non-selective and may traumatize healthy or healing tissue
Time consuming
Can be painful to patient
Hydrotherapy can cause tissue maceration. Also, waterborne pathogens may cause contamination or infection. Disinfecting additives may be cytotoxic.

Surgical Debridement:
Description:
Sharp surgical debridement and laser debridement under anesthesia are the fastest methods of debridement.
They are very selective, meaning that the person performing the debridement has complete control over which tissue is removed and which is left behind
Surgical debridement can be performed in the operating room or at bedside, depending on the extent of the necrotic material.
Best Uses:
Wounds with a large amount of necrotic tissue.
In conjunction with infected tissue.
Advantages:
Fast and Selective
Can be extremely effective
Disadvantages:
Painful to patient
Costly, especially if an operating room is required
Requires transport of patient if operating room is required.

Maggots
Click here and scroll down to see the nasty pictures.
These images were supplied by David Janssen, M.D.
Dr. Janssen used to have a very detailed website, but now it's gone.
Other web resources, click here.

Folks, as a trained medical person my stomach is made of fairly strong stuff. During my EMT training we would eat our dinner while viewing slides of gruesome trauma and none of us were fazed. But maggots in a wound, and me knowing they were there? That makes my stomach turn in ways I didn't know it could! Sorry, arm/leg/whatever, but there wouldn't be any saving you if there were maggots involved! Excuse me while I go lose my lunch.

Hopefully the advancements in burn care and reconstruction will continue--without maggots, thanks!

Cie

Marfan Syndrome

What do a former U.S. president and a Swedish heavy metal singer have in common?
Possibly Marfan syndrome.
Marfan syndrome is an autosomal dominant disorder that has been linked to the FBN1 gene on chromosome 15. FBN1 codes for a protein called fibrillin-1, which is essential for the formation of elastic fibers found in connective tissue. Marfan syndrome is also an example of a dominant negative mutation. Marfan syndrome is associated with incomplete penetrance, therefore not all persons carrying the mutation develop the disease.
Without the structural support provided by fibrillin, many connective tissues are weakened, which can have severe consequences on support and stability. The most serious conditions associated with Marfan syndrome primarily involve the cardiovascular system. Marfan syndrome may cause leakage of the mitral or aortic valves that control the flow of blood through the heart. This may produce shortness of breath, an irregular pulse, and undue tiredness. Another complication is aortic aneurysm.
Curvature of the spine (scoliosis) is a common problem, as is abnormal indentation (pectus excavatum) or protrusion (pectus carinatum) of the sternum. These symptoms may in turn cause unusual pressure on the heart and lungs. Other symptoms include; abnormal joint flexibility, high palates, flat feet, stooped shoulders, and dislocation of the optic lens.
Nearsightedness or myopia is a common condition associated with Marfan syndrome. In addition, the weakening of connective tissue often causes detachment of the retina and/or displacement of the lens in one or both eyes.
Quoted from Wikipedia

Marfan syndrome sufferers may grow to larger than normal height, and typically have long, slender limbs and fingers. Their arm span usually exceeds their height. (For instance a person of 6'6" tall would normally have a 6'6" arm span. A person with Marfan Syndrome at this height would likely have a 7' arm span.) Their arms and legs are strikingly long in comparison with the torso.



















Abraham Lincoln was 6'4" tall and weighed around 180 pounds.



















Per Ohlin was 6'4" or 6'5" tall. His weight was likely comparable to that of President Lincoln.

















Persons with Marfan Syndrome sometimes have fingers with a long, thin, spidery appearance known as arachnodactyly.









































































These photos show the markedly angular facial features in both subjects. Both men have a prominent, angular nose with a strikingly broad bridge.

Of course not all tall, slender individuals have Marfan Syndrome. Basketball star Michael Jordan is 6'6" tall and weighs 215 pounds. He exhibits none of the characteristics of Marfan's.

For more information on my models:
Abraham Lincoln (February 12, 1809-April 15, 1865)
Per Ohlin (January 16, 1969-April 8, 1991)

A personal note:
Although not a trait associated with Marfan Syndrome, I find it interesting that both Lincoln and Ohlin suffered from mood disorders, either major depression or possibly Bipolar Type II as both had periods when they described moments of elation or high energy uncharacteristic to their normally melancholy personalities. Lincoln once described himself as being the most miserable man alive. Ohlin committed suicide at the age of 21.
Both of these individuals possessed remarkable qualities far beyond being interesting subjects for scientific observation. They were both highly intelligent. Lincoln was a noble humanitarian and Ohlin a gifted poet and musician. I mention these aspects because I believe in the importance of focusing on a person's soul before their physiology.

Skin Repair

I never realized all the cool stuff that goes on beneath the surface of a scab! Click the title link, then follow the steps below to see it for yourself.
Go to the top left sidebar where it says Click Here to Choose a Unit
Choose Levels of Organization
Click on Tissues
Click on Membranes
Click on the "filmstrip" icon and then click on Next in the picture at the top of the page to follow the slide show!

Just Thinking!

Click the title link to read a fine speculative article from respected sci-fi author Orson Scott Card regarding the new scientific attitude towards genetics and what it may mean for future generations.

Angelman Syndrome

This neurological disorder is caused by a deletion or mutation on the mother's contribution to the 15th chromosome. People with this condition have developmental delays but are generally happy and friendly. They enjoy certain sounds such as flowing water and crackling paper. They have a tendency to make big flapping motions with their hands. They are sensitive to high temperatures. Many of them can learn to perform simple tasks on their own.
Here is an excellent site about Angelman Syndrome.
If the deletion or mutation were on the paternal contribution to the 15th chromosome, Prader-Willi syndrome would result. People with this condition tend to be small in stature and suffer from polyphagia. They also suffer from developmental disabilities.

Fitting In Your Genes

In my A&P class, we are currently studying genetics. I'm fascinated by anything to do with genetics although the intricacies of DNA are a bit overwhelming. I enjoy seeing if I can tell what a person's ancestry is by looking at them and may delve into this a bit. I'm also interested in genetic abnormalities. I know that I have a couple. Bipolar disorder is caused by a mutation, I believe on the 15th chromosome. I also have a mild nonspecific neurological disorder that may or may not be related and when I'm very tired will lead to facial tics and muscle jerking. I have a blog all about abnormal psych issues and will tend to stick to physical issues here, and sometimes the two will overlap. I'm hoping that this will be a fun and interesting if somewhat sporadic project!

Medical Hodgepodge Blog

I work in the medical field. I've always been fascinated by stuff that people shouldn't be fascinated by such as diseases and decay. Not fascinated as in "turned on," simply wondering how and why this stuff happens. Kinda like the way one doesn't want to look at a horrific accident but can't help but peek through their fingers. So many strange and interesting things can happen to the human body. I'll share some of these things along the way.