are you ready to die?

i know that sounds a bit macabre, particularly in light of this joyous holiday season, but as the year unwinds, i think it's a question that everyone should consider, sooner rather than later. now, oddly enough, i'm not even talking about the spiritual component which is what you might expect around christmastime. i'm actually talking about the realm of living wills and advance directives.

let's talk about dnr's first. a dnr is a "do not resuscitate" order. that means, in the event of a respiratory or cardiac arrest, there will be no cpr--no intubation and hooking the patient up to a ventilator, no cardiac shocks, chest compressions, no "heroic measures" or any of the other things that occur in a "code" situation. now, in the event that you are a 90 year-old woman with metastatic breast cancer, severe dementia and so debilitated you haven't been out of your bed in the past year, the decision for you or your family to make you a dnr seems pretty easy.

however, in many situations, it's not as clear cut. i have had a number of patients who were made dnr or about to be made a dnr who ended up surviving and leaving the hospital alive. they subsequently led happy and productive lives, at least for some time after discharge.

but what if you were a 97 year-old and you developed a tear in your aorta which could only be corrected surgically? if you don't get the surgery, you will probably die. if you do get the surgery, you will probably die. would you rather die peacefully at home or on the operating room table? the answer seems to be easy, except in this case, the patient was michael debakey one of the most renowned surgeons in history. he actually pioneered the surgery that he now needed. i think i have linked to this article before but here's the link again to a fascinating article in the new york times a couple of years ago. he refused his surgery and wanted to die in peace. only after he became comatose, his wife begged his colleagues to perform the surgery and after a special ethics meeting, they agreed to proceed. he survived the surgery and lived for another couple of years, long enough to receive the congressional gold medal from president bush. the funny thing is, even though he intially refused surgery and was ready to meet his maker, after the whole ordeal he was happy his wife did what she did. if the famed dr. debakey can make a mistake regarding a dnr order, how is the average joe on the street supposed to know what to do?

that's why i feel like it's good to have a surrogate medical power of attorney or medical decision-maker. in some young patients, it's appropriate to withdraw care. in some much older patients, it's appropriate to continue fighting. i think if you have an advanced directive specifying exactly what you want or don't want done to you if you aren't conscious to make those decisions yourself, you may be potentially making a tragic mistake. would you always refuse being hooked up to a ventilator? some people specify that but what if it's just for a day or two while your lungs recover from a bad pneumonia? frequently, we have patients on ventilators only for a few days and they get better and eventually go home. however, if your advanced directive refuses this care, you could potentially succumb to a disease you shouldn't have.

the point is, each situation should be evaluated on its own, which is why i feel (at least right now) that it's best to have someone make the decision for you. hopefully that person has some type of medical knowledge or background which would make the communication and decision-making easier. naturally, one would assume that the spouse should be the one making these decisions and they probably should, but other times it might be more difficult. if your loved one is actively dying despite all medical care, it would be very difficult to tell the doctors to withdraw care. sometimes people want to make this decision on their own, sometimes they want some reassurance from someone else that this is the right decision. whatever is right for you or your family, if you don't have an advanced directive, make sure someone is designated to make those decisions. if not, what happens frequently is that family members disagree about the care and that itself eventually turns into a mess.

n'awlins

do you know what it means to miss new orleans? that's how the old line goes in a song sung by many. well, i know harry connick, jr. sang it but not sure if he originated or not. if he did, then way to go harry, i like that song. anyway, karen got us tickets to see harry at the cobb energy performing arts center (stunning name, i know) earlier this week. he has a new christmas album out which he was promoting. the holiday songs were fine (don't get me wrong, i like a good christmas tune like anyone else but as he mentioned during the concert, it does tend to get a little nauseating after a while, particularly some of the pop songs) but his jazz/blues/etc. pieces were great. i would say almost half of the concert was non-holiday music, including a little jambalaya ("crawfish pie, file gumbo") and a mardi gras piece at the end ("if you go to new orleans, you oughtta go see the mardi gras ..."). check out karen's blog for a more complete description. and yes, i agree that the concert at chastain a few years ago was one of the tops.

all that brings up the question, do you know what it means to miss new orleans? i actually do miss new orleans, having gone to college there. of course i don't want to romanticize the city too much. sure, there was a lot of crime (note these reflections are from the early '90's when i was there), lots of corruption and poverty. there was a particular stench that would roll in off the swamps a couple of times a week and give the city the smell of an outhouse. the humidity was at times unbearable. i remember the first time i ever visited. it was late august, a week before orientation (yes, i decided to go there without ever visiting! that's another story.), probably 8 pm or even later. i slid open the door to the dodge caravan and whoosh! a suffocating cloud of atmosphere invaded us and i thought i was going to pass out. kinda like houston from what i hear and it's not like it doesn't get humid in atlanta but new orleans is at another level. in addition, the city's kinda dirty and covered with potholes.

but ...

i guess those are some of the things that gives the city character. and in a weird way you kinda miss those things (okay, not the crime and poverty but you know what i mean!) ... although i probably miss the times as much as the actual things. i mean, i don't really miss getting sweaty walking a few hundred feet to class at 8 in the morning! but i do miss the people, the accents, all the great music--so much great music both big names and small, the streets lined with trees and spanish moss, the mississippi river (one of the first things i did when i got to tulane was to put my foot into the mississippi like ol' sam clemens might have done years ago), weekly crawfish boils, cheap po' boys and all the glorious food including $5 all-you-can-eat fried chicken and red beans and rice with sausage on mondays at dunbar's (!!!), mardi gras parades and mardi gras music (i love mardi gras music), streetcars, hanging out at the levee (but with my ford mustang, not a chevy) and yes, even the french quarter, beignets at the cafe du monde, and so many other things. i miss those beignets. we even got some once at a cafe du monde in a mall in nearby metairie but they weren't the same as the one in the quarter. i haven't been back since katrina and i heard things are still a bit depressing there although better. hopefully we'll be back sooner than later.

holy moly

yes my friends, i'm back. it's been almost a month since the last post. time flies when you're busy watching tv ... i mean, saving lives in the hospital.

my parents are in cancun right now. that scares me. they usually travel with friends or other korean travel groups so i don't worry about them as much but this time they're on they're own. do they speak spanish? no. fortunately it's enough of a tourist town to where enough natives speak english. is there a good chance they'll get swindled? yes. will they manage to get from the airport to the hotel in a timely fashion? not sure. what will they do while they're there? don't know either. typically koreans take food and cooking utensils (think rice cookers, pots, portable flame or electric burners, coolers, etc.) with them on trips and cook in the hotel room or wherever they're staying. it was like a freakin' korean market when we were at a marriott timeshare in california a few years ago. my brother had the timeshares and there were 2 units next to each other and the fridge was filled with korean food to cook and cook we did. i felt bad for the next occupants because the rooms stunk like korean food after a week of saturation with garlic, kimchee, fermented bean paste and other odd smells.

anyway, my parents are in cancun because my dad just wanted to go to cancun. i am my parents' unofficial travel agent. i'll get a call from them every once in a while asking me to book a flight using skymiles. of course, usually this is unsuccessful because those you-know-whats hardly ever have a flight you want. and when they do, you have to pay an extra $100 or more because you booked the flight too close to the actual departure date.

the good news for my parents' survival is that my mom did come to a tiny little town in georgia 30 some odd years ago with several other korean nurses, none of whom spoke english, and somehow made it.

which brings me to another point, no matter where you go in this world, if it's of any tourist value, you can usually find a group of koreans there. at sacre coeur on a hilltop in paris? koreans. karen freaked some of them out by saying "hi" in korean. they laughed. my parents also went with a busload to vancouver. imagine if you're minding your own business at a random ski resort in vancouver and a busload of koreans descend on your property. meals were included in this package and i remember my mom telling me that one of the restaurant people asked her if there was an egg shortage in korea because they were tearing up the hard-boiled eggs on the buffet. no, koreans just like to take advantage of free meals (e.g., me and drug rep dinners) and apparently they were taking the eggs with them to eat for later as well. this was discovered by the staff when all of the eggs were gone but there were few shells on the tables.

well, here's a glass to you mom and dad, wherever in mexico you are. here's to safe travels.

back in action

just wanted to give a quick word on an article i came across. click here for more details. basically it's a study showing larger bmi (body mass index, a measure of how "big" you are) women were sexually as active as thinner women, maybe even more so. what i love about the story is the following quote from one of the researchers: "These results were unexpected and we don't really know why this is the case," Kaneshiro said. ha ha ha! that is freakin' hilarious, nice little jab at the large people in this world.

the incredible ... kate?

check out this hilarious video of our lovechild as the incredible hulk. i used to love that show.

thank ye

props to my colleagues at the acp internist blog. i've been linked on their site (see under sept 29 post). recently i came across their "medical news of the obvious" posts and found them very entertaining. i have to say, they took an idea i'm sure many of us have had but actually put it to print. i come across a lot of articles in my weekly perusings and a number of them come to such obvious conclusions, i wonder why someone actually spent time and money to publish it. maybe that's the point, to get their name in print. heck, let's be honest, i'm mostly jealous!

"never" events

well, this is october 1. another day, another month you say? not quite, today marks the day that cms (center for medicare and medicaid services, responsible for the largest share of and policy directing physician payments) will stop paying for "never" events. what are these? these are events that in the mind of cms, they/we/the government will not pay for since they feel if proper measures are taken, they would never occur in the hospital. see among many others this site to list the events.

certainly, improved quality in the hospital has to start somewhere but to all of a sudden deny payment seems a little drastic. okay, i can understand that they wouldn't pay for complications related to a severe reaction from a blood transfusion. that is usually due to a clerical error. i can even understand that if a surgeon operated on a patient and left an instrument inside accidentally, there would not be payment to cover treatment for those complications. however, some events, no matter how vigilant or good the treatment, cannot be prevented 100%. for example, a deep vein thrombosis or pulmonary embolism (which i will discuss in a later post) after knee or hip surgery is not a completely preventable event. even if the surgeons use proper medication to prevent these clots from forming, the fact is, the medications are not 100% effective! somehow this obvious fact has escaped the mind of cms. well, more on that later. i need to eat some ice cream and go to bed.

patient behavior

at the risk of alienating some patients, check out this hilarious article on patient behavior. not sure how long the link will last but worth reading. here's the original article on medscape. there's a chance you might need to register to read it but give it a try.

"two protons walk into a black hole ... "

if you have access to the wall street journal, check out this article. pretty funny. it's about physicists taking a workshop on how to be funny. i think i like the line in the article "do my bosons give you a hadron" even better. there's no limit to how funny physicists can be. i'm sure there's an integral in there somewhere ... limit of physicists as funny approaches infinity.

all this of course is tribute to the large hadron collider, which recently went into operation. click here to get more info on this. here's another link to some physicists having a pajama party to celebrate. now that sounds like a party i don't want to miss. hey, my undergrad was in mechanical engineering so i feel i have clearance to make fun of science and engineering nerds.

ca

sure, in your science class, ca might refer to calcium or california in geography or something else in some other class but if you hear your doctors talk about ca, they're talking about cancer. sometimes we use it when we don't want to alarm patients, families or others who may be in earshot, particularly when we don't really suspect it but do need to consider it in the possibilities of what might be wrong with someone. obviously, if your doctor has a fairly low suspicion of cancer but are doing a couple of tests to "rule it out" then you don't necessarily want to worry about it for days while the tests are pending. all you want to hear is, "oh yeah, whatever you have, it's not cancer." well, not to be paternalistic, but at least to me, i certainly wouldn't want to be worrying about it.

a couple of questions came up about prior ca topics. as for screening, colon cancer seems to be more straightforward but it's certainly not the case for breast cancer. unfortunately, no matter what type of cancer, there are always particularly aggressive forms in some people that defy all screening. we see patients with no family history of cancer who come in with colon cancer diagnosed in the 20's and 30's, breast cancer in the same range too. screening would not have helped and these patients aren't usually the ones who live a long life. these are usually advanced diseases we see in the hospital. those are the unfortunate outliers. screening programs are basically a numbers game--how prevalent is the disease in a certain group, how good are the tests, how much will all of it cost, etc. if you have a strong family history of breast cancer, as far as i know of, there are no clear-cut guidelines on early screening. of course, most recommend an early baseline mammo then yearly (or every other year) starting at age 40. but what if you're 20, 25 years old? there are genetic testing options for the brca gene but that probably shouldn't be done without counseling from a medical geneticist because the answers aren't as straightforward as you might think.

a friend also commented on gene upshaw, the former nfl'er, players union director who died somewhat suddenly of pancreatic cancer. again, some cancers in some people can be particularly aggressive. he was apparently sick at least for a little while (but not too long) but didn't get seen by a doctor. some cancers don't manifest themselves until it's almost too late. that's part of the reason the mortality for ovarian cancer and pancreatic cancer are so high. i just read another nice q&a session on the scientific american website here. more good info regarding cancers, particularly pancreatic. i'll talk about prostate cancer screening later, another very controversial area.

medical myths

there was an article in the british medical journal last year about certain medical myths. i am a little jealous because i could have written the article and had my name all over google and pubmed if i had thought of the idea but i didn't. isn't that the way with most things in life? anyway, it proclaims "sometimes even doctors are duped." if that's the case, i would say find another doctor as most of the ones listed were fairly basic old wives' tales (not to say doctors aren't duped or wrong a LOT of times because they are). the problem in medicine and in life is that we don't view things with a critical eye and believe anything people tell us, even if they're a physician. anyway, the article is an interesting read. check it out here.

ha ha, this came up because of a comment on my #1 fan's blog about how maybe sitting too close to the computer all these years made her eyes bad. apparently her optometrist told her this. well, hate to break the news but this is a myth. dim light or sitting too close to the tv or other objects does not make your vision bad.

another myth i want to demythologize (i made that up) is the ol' "sugar rush" that people, particularly parents, talk about. sugar does not make you hyper! i remember reading a long time ago that kids make other kids hyper, not sugar. in other words, when kids are at parties with other crazy and rowdy kids, it's the environment that makes them hyper, not the fact they got in a few cupcakes. john stossel even had a mini-study on 20/20 recently where they gave kids junk food which was actually low in sugar but the parents thought they were high-sugar snacks. of course they all had the impression that the kids were more hyper than usual. then they gave the kids healthy food but loaded with sugar and the parents thought they were calmer than usual. of course the parents were surprised when they were let in on the experiment. hmmm, i wonder if they got informed consent from the parents for the study?

anyway, this makes sense physiologically, too. okay, if you're completely comatose and hypoglycemic, i can see how giving sugar in that instance would increase your energy level. however, excess sugar stimulates insulin which is not a hormone known for revving up the body.

"the eagle has landed"



these were the words spoken by my wife when we got our phones in the mail. now, just to be clear, there is a backlog on iphones so the phones which came were my wife's and my parents' phones (none of which are iphones and we're all on one family plan now). however, this was a big step in my iphone access process. you see, i have had sprint service for 8 years. as a matter of fact, i recently checked my last bill and had a "congratulations on your 8 year anniversary" message. however, over time, and more importantly in my current job, i have become increasingly irritated with dropped calls. this even happens at our condo. i can have 4 bars then all of a sudden lost signal. this is even more aggravating when you have to make business or professional calls. people really get annoyed when you keep cutting out. so, we made the switch to at&t which, without a doubt has better signal reliability (although still a step behind verizon). just to let you know, i'm not entirely satisfied with this move because to sprint's credit, the voice quality of their phones/lines i feel is much better than at&t. you can drive in your car with the windows down and the other person can hardly tell. with all of our at&t phones, the background noise is much worse. however, background noise with a signal is still preferred over no signal at all.

having said all that, after we made the switch, i went to the at&t store and ordered my iphone, 3G that is. the expected wait was 10-21 days but one week later, i got an email that said the phone had arrived at the store. of course, the email says to wait for a customer service person to call to schedule a pick up time but whatever! i just went right to the store and it was there ready for me.

so, the pic above is me playing with the 2 loves of my life, my baby and my iphone. ha! just kidding!!! of course my wife and kid are the real loves of my life. the iphone would be a distant, distant 3rd.

tribute to norman

on a more serious note, i just wanted to write a short tribute to my good friend's dad, norman, who died last week from metastatic lung cancer. i've known my friend since 7th grade and what i always remember about his dad is his voice because it was on their answering machine growing up: "hello, this is norman ... " i always found it funny that the greeting sounded like he lived alone and didn't really mention the family.

to be quite honest, what was most troubling about the past few months with my friend and his dad was that he was diagnosed with cancer about 2 months ago and succumbed to it fairly quickly after diagnosis. you might think that he was in some remote area or never really saw any doctors but the fact was, he lived in a suburb and was being followed by many doctors, including a pulmonologist. i don't want to criticize any of his doctors because i know nothing about his prior workup and clinical condition but what angers me is that i feel his diagnosis should have been made much earlier. it's not like he all of a sudden became sick. he has had issues for longer than the past 2 months. of course some might ask, "would it have made a difference?" in his outcome but i don't think that is a relevant question. yes, lung cancer has a high mortality rate but with earlier diagnosis, there is a high likelihood that he would have been around much longer to enjoy his life on earth. and i'm not talking about keeping alive some demented and debilitated patient a few weeks longer to prolong his misery but i'm talking about early diagnosis with hopes at cure. well,what's done is done and i pray for peace and comfort for his family and friends.

cpr article

karen's friend kristi writes for the knoxville news sentinel and has an article about cpr covering the compression-only concept that i discussed previously. (am i really "discussing" it if i'm just writing about it on the blog and not actually talking with anyone? guess not. reminds me of a friend who asked if you could be a "wino" if you drank beer or liquor and not wine. initially i thought it could apply in general to anyone who drinks a lot but then the question was asked why that person was called a "wino" and not something else to which i had no answer. i guess alcoholic, alky, etc. could apply to such a person so it does seem that wino belongs exclusively in the realm of actual wine drinkers.) i had the honor of getting quoted in the article. check it out here. i can be korea's (or shall i say "korea-america"?) answer to sanjay gupta. watch out cnn.

on oregon and death

nothing profound here, just a link to a fox news article. apparently, a guy was signing up for oregon's state-run health plan and instead of an offer to help treat his metastatic prostate cancer, he got a letter offering physician-assisted suicide! okay, there's more to it than that but that's the gist of the story.

chemo and other costly therapy for terminal illnesses or late-stage disease brings up a dilemma regarding whether patients should undergo these therapies even if they offer only minimal benefit (tack on a few months at the end of life). there was another interesting ny times article regarding this issue recently. in many places where the government is the provider, they make the decision for you--minimal benefit, we ain't gonna pay. being the capitalist that i am, it is definitely against my nature to say that having less choices makes life easier but that is the certainly the case in some situations, for sure (like oh my gosh). if you have ever shopped around for a flat-screen hdtv, you know what i'm talking about!

medical minute

please note, this is just generic info and not specific medical advice. if you have any medical problems or questions, please discuss these with your doctor.

i love those little disclaimers on commercials and such.

anyway, for real, i wanted to give a little more update on tony snow and colon cancer. i remember hearing that his mom also died of colon cancer but what i didn't know was that she died at the age of 38! now, i'm just assuming once tony hit 50 or somewhere near there he started seeing doctors since he would need to be screened for colon cancer at that age. i'm assuming that was the case because i never want to second guess a physician (always give the benefit of the doubt i say, you never know the whole story ... well, having said that, once you know the whole story and someone was still grossly negligent, let 'em have it!). the reason you would be second guessing is if a physician actually recommended he wait till 50, that would constitute gross negligence. any medical resident (i.e., "physician in training") knows that if you have a first-degree relative with colon cancer, then the age you should be screened is 10 years before the age that relative was diagnosed, or at age 40, whichever comes first. i'm not sure if/when tony's mom was actually diagnosed, but since she died at 38, that means he should have been screened at least by 28 with a colonoscopy. as far as i can tell, he first got screened at 50 when he was ultimately diagnosed. i just read some source that said he started having abdominal pain which led to the testing. it's amazing and ironic that the white house press secretary of all people may not have gotten notified by someone, even a physician friend, that he was way overdue for a colonoscopy. very sad. who knows what the outcome might have been if he had known that he needed screening much earlier. then again, at the time he was 28, i can't say for certain that those recommendations were even in place. certainly some room for investigation. still, these aren't exactly new recommendations so the word has been out for some time.

to die at age 38 from colon cancer is not a common occurrence. most colon cancers are not familial and typically grow out of polyps which take time, thus the age 50 recommendation. however, a small percentage of cancers are familial and are diagnosed at much earlier ages.

so, again, if you have a first-degree relative (sibling, parent, etc.) diagnosed with colon cancer, note the age! you should be screened for colon cancer 10 years before your relative was diagnosed, or at age 40, whichever comes first. if your mom got diagnosed with colon cancer at age 45, you need screening at 35. now, the question comes up as to which screening tool is recommended but for all intents and purposes, colonoscopy is probably the way to go. for more detailed info, click here to see the american college of gastroenterology's input.

r.i.p. dr. debakey

with the rash of media personality deaths lately, i must include the death of dr. michael debakey. he actually died on the same day as tony snow but for some reason i didn't hear about it until yesterday. most med students probably hear debakey's name before knowing anything about him because he has a surgical clamp named after him. dr. debakey was a pioneer in surgeries of the heart and aorta and one of the most well-known and respected surgeons/physicians around. he was responsible for coming up with the idea of mash units among many other inventions and ideas. there are many obits around but here's one from across the pond. i like his quote on operating on kings, heads of states and the less fortunate: "Once you incise the skin, you find that they are all very similar."

there's an article in the new york times that came out last year that is a fascinating read if you have a few minutes. here's the link. basically, he suffered a problem for which he pioneered the surgical treatment but he didn't want the surgery. he was 97 at the time and assumed he would be dead but ended up surviving for weeks. when he got ill enough to refuse care, his wife begged the staff and they did the surgery. debakey recovered and actually thanked them for doing the surgery and he was glad to have another chance. this article really made me rethink the issue of advance directives and "dnr" (do not resuscitate) orders. more on that later.

r.i.p. tony snow

in case you didn't hear, tony snow died this morning after a battle with colon cancer. here's an nytimes story. in case you didn't know, he was a christian as well. here's a christianity today article he wrote. big losses in tvnews/politics lately with tim russert's recent death as well. i guess a reminder to all about the brevity of life.

thank you, thank you

i hope to surprise my SIL (sister-in-law for all you people who don't spend disturbingly large amounts of time on the internet) by thanking her for listing me in her award list for blogs she likes. odd sentence structure there. whatever, i'm too lazy to change it ... but apparently not too lazy to write another sentence about how i'm lazy. interesting. anyway, i'm also supposed to list this website which apparently started the award. here's the award pic below also. i do hope this award was legit; as anne mentions on her blog entry, there may have been a family bias to her awards. i don't want this thing to be rigged.

viewer mail

okay, i'm gonna spend a minute discussing some important questions that came up in a viewer comment regarding the recent cpr post.

first, the aha (american heart association) advisory committee and i want to emphasize that whether you do traditional cpr with mouth-to-mouth or compressions-only cpr, the survival is similar. having said that, another way of looking at it is that, if there is any concern or hesitancy about the mouth-to-mouth part, feel assured that chest compressions only will offer similar benefit. read the aha press release here.

second, remember that this is for out-of-hospital, witnessed cardiac arrest. this is not applicable to witnessed "fainting" (or "falling out" as our hospital population calls it ... incidentally, apparently karen's side of the family had never heard this term. i hear it so often from our patients that i assumed it was common but apparently that's true only in certain populations). if someone faints, typically there is an inciting reason (stood up too fast, gross movie, etc.) and they will "come to" (is this another one of our inner city terms?) fairly quickly. if someone has cardiac arrest, they will NOT spontaneously wake back up. if you are adept at feeling pulses, they will also likely not have a pulse.

third, for the most part, this is for adults only (sort of like an r-rated cpr). most kids, younger folk, drownings, drug overdoses, etc. typically have respiratory arrest and in those cases, oxygen (via your mouth) is the most important factor for survival. so, in kids, lack of oxygen is the problem leading to heart and brain injury. in adults, it's usually the heart problems that lead to the brain and oxygen problems.

next, how long do you do compressions before you perform mouth-to-mouth? i'm not sure if there's an official answer to this but you can probably go at least 4 minutes or more before giving the rescue breaths.

do you ever stop compressions to see if they're breathing? short answer, no. assuming it's true cardiac arrest, your chest compressions will not get their heart kicking again and they will not spontaneously breath until it can get jump-started. this typically occurs via electricity, i.e., shocking someone. either that or correcting other underlying disorders which only the paramedics will be able to potentially do.

what's the best position? there is no official preference for side-by-side compressions or compressions while straddling the person. however, in my opinion, straddling the person may actually be more beneficial because the weight on the abdomen theoretically could help improve blood return to the heart by basically squeezing the blood out of the abdominal organs. not to throw anyone off, but there's even evidence and a push by some people for "abdominal" compressions instead of chest. see this interesting story.

so, in summary ...

1. chest compressions only is an alternative to traditional cpr with compressions and rescue breaths.
2. this method only applies to adults who have witnessed cardiac arrest. anyone with obvious airway problems needs oxygen!
3. continue compressions until ems arrives. if it takes longer than 4 to 5 minutes, consider giving some rescue breaths.
4. don't stop compressions for anything (except rescue breaths). if a patient miraculously starts breathing spontaneously, you will know it and can stop. in general, however, a person will not wake up from sudden cardiac death unless ems or the hospital staff intervenes (unless, of course, an aed--automated external defibrillator--is available).
5. compressions is better than nothing.

hope this helps.

happy b-day kiddo!

okay, i can finally wish kate a real happy birthday, not happy 173rd day of life or happy 7 months as in the past but happy 1 year! that's right friends, one year ago today, kate made her descent down the ol' birth canal and into this world. (karen loves it when i talk this way.) i don't think the shape of her head has quite recovered from the trauma. ha! fortunately for me, being in the medical field, i have seen much more traumatic and dare i say messier stuff so the process itself didn't bother me too much.

so many highlights from the past year. look for karen's postings to come for a lot of other stories but first, here's a video of a "dueling growls" game that kate and i play. not sure how it started but kate started making this noise so i decided to do the same and now we do it back and forth to each other. sometimes i use it as a mini-gps device--if i don't know where she is i'll make this noise and listen for a response to locate her.

one of the joys of being a parent is watching the funny and quirky little things she does, especially at this age when she doesn't really know what she's doing (or so we think). i actually find most things she does funny in some way. a very brief listing of some funny memories: swinging things in front of her (with the rare bonking of the head with said object) and then at times just swinging her empty outstretched arm for no apparent reason; lowering her head when she goes into turbodrive crawling; her first balloon experience (kid went craaaazy); how her face would (and still does to a less extent) get all splotchy when she cried hard; tooting sometimes when she strains from crying also.

she loves "undoing" things these days--taking things out of boxes and purses, throwing things off of tables, pulling books off of shelves, cd's off of racks and junk out of drawers. tends to make the place very messy.

phases i'm happy to see pass: spitting her food at us (didn't last too long thankfully), not having to make as much formula or clean as many bottles (although of course this gets replaced with bowls and spoons and sippy cups ... but still better than cleaning bottles i say), 2 words--breast pump, having to burp her (which i didn't really mind but just something that has passed), sleeping exclusively on our loveseat.

okay, lots more i could add to the above but i need to get this post out before midnight so till next time. happy birthday katherine suna!