“About 6 of every 10 (or 60%) of men and 5 of every 10 (or 50%) of women experience at least one trauma in their lives. Women are more likely to experience sexual assault and child sexual abuse. Men are more likely to experience accidents, physical assault, combat, disaster, or to witness death or injury.”
US Dept of Veteran Affairs
“PTSD was first brought to public attention in relation to war veterans, but it can result from a variety of traumatic incidents, such as mugging, rape, torture, being kidnapped or held captive, child abuse, car accidents, train wrecks, plane crashes, bombings, or natural disasters such as floods or earthquakes.”
National Institute of Mental Health (NIH)
In honor of all men and women who have served our country thank you!!
I have committed myself in caring for people as a RN over 28 years and for the commitment you have made in keeping the USA safe with any sacrifices you made from the bottom of my heart thank you!! I dedicate this article to all acting and retired veterans.
Post-traumatic stress disorder (PTSD) is a mental health condition that’s triggered by a terrifying event — either experiencing it or witnessing it. Symptoms may include flashbacks, nightmares and severe anxiety, as well as uncontrollable thoughts about the event.
Many people who go through traumatic events have difficulty adjusting and coping for a while, but they don’t have PTSD — with time and good self-care, they usually get better. But if the symptoms get worse or last for months or even years and interfere with your functioning, you may have PTSD.
Getting effective treatment after PTSD symptoms develop can be critical to reduce symptoms and improve function.
The Mayo clinic states you can develop post-traumatic stress disorder when you go through, see or learn about an event involving actual or threatened death, serious injury or sexual violation.
Doctors aren’t sure why some people get PTSD. As with most mental health problems, PTSD is probably caused by a complex mix of:
Stayed tune for Part II this weekend on PTSD.
Children with Williams syndrome are extremely sensitive to sound and may overreact to unusually loud or high-pitched sounds (hyperacusis). Chronic middle ear infections (otitis media) are often present.
National Organization of Rare Disorders
“A study just published by Clinicians on patients in the West Midlands who travelled overseas to receive Living Donor transplants has found that clinical outcomes are often poor. Over 30% of the patients in the study who travelled either died within three months (17%) or lost their new kidney within a year(14%).”
National Kidney Federation
When people languish on a wait-list for a kidney transplant, they may start to consider a desperate measure: Traveling to a country where they can buy a donor kidney on the black market.
But beyond the legal and ethical pitfalls, experts say, the health risks are not worth it.
Most countries ban the practice, sometimes called “transplant tourism,” and it has been widely condemned on ethical grounds. Now a new study highlights another issue: People who buy a donor kidney simply do not fare as well.
Researchers in Bahrain found that people who traveled abroad to buy a kidney — to countries like the Philippines, India, Pakistan, China and Iran — sometimes developed serious infections.
Those infections included the liver diseases hepatitis B and C, as well as cytomegalovirus, which can be life-threatening to transplant recipients, the investigators said.
Also, people who bought donor kidneys also faced higher rates of surgical complications and organ rejection, versus those who received a legal transplant in their home country.
Dr. Amgad El Agroudy, of Arabian Gulf University, was to present the findings Friday at the annual meeting of the American Society of Nephrology (ASN), in San Diego.
It’s not clear how common it is for U.S. patients to take a chance on traveling abroad to buy a black-market kidney, according to Dr. Gabriel Danovitch, director of kidney transplantation at the University of California, Los Angeles.
“We really have no way of knowing what the numbers are,” said Danovitch, who was not involved in the study.
“But,” he added, “my sense is that the numbers are fairly small, as the dangers of transplant tourism are becoming more and more clear.”
Why is it a risky proposition? According to Danovitch, there are a few broad reasons: The paid organ donors may not be properly screened, and the recipients may not be good candidates for a transplant, to name two.
“In a paid system, the prime focus is on making money,” Danovitch said. “Centers that are willing to do these don’t really care what happens to the donors or recipients after the transplant.”
For people with advanced chronic kidney failure, the treatment options are dialysis or a transplant. But there are not enough donor organs to meet the need. In the United States, nearly one million people have end-stage kidney disease, and there are roughly 102,000 people on the waiting list for a transplant, according to the National Kidney Foundation.
Kidney transplants can come from a living or deceased donor, but living-donor transplants are more likely to be successful, according to U.S. health officials.
It doesn’t take long to get tired of spending 12 hours a week on hemodialysis, or even more time on peritoneal dialysis (PD) —not to mention complications like line infections and access problems. But a new, healthy kidney would put an end to all that. A transplant sounds like it would be well worth the risk of surgery and the trouble of taking anti-rejection medicines, and Medicare statistics show that it actually costs less in the long run than continued dialysis. When can you check into the hospital, you ask?
Unfortunately over 80,000 people in the United States are already waiting for a new kidney and in 2008 only 16,517 got one. Maybe you don’t have a compatible donor in your family, or you’ve been told that you are “not a transplant candidate” for one of several reasons. You’re a resourceful person who knows that persistence pays off, and you start looking for ways to shorten the wait or get around the rules that say you don’t qualify for a transplant. Kidneys from living donors are almost always preferable to those from recently deceased donors. If you don’t have a friend or family member willing to donate, what about getting one where the laws against buying an organ are less strictly enforced? Medical tourism is booming these days. Maybe you know somebody who had surgery overseas, either to avoid a waiting list or just because the price is lower there. The same international pharmaceutical countries produce medicines for everybody these days, so how big a difference can there be? Nephrologists in the US say it’s a common story: a dialysis patient misses treatments or appointments for a few days or several weeks, then comes to their office asking for refills on anti-rejection medicines…with pill bottles labeled in Urdu, Chinese or Farsi as well as in English. Did they get a good deal or what? Unfortunately this may not be the bargain people hoped for.
At UCLA Jagbir Gill, MD, and associates studied 33 patients who had received transplants overseas, and found they had much worse results than patients who received transplants in this country. Screening of paid kidney donors was less thorough, with problems like hepatitis overlooked. Early organ rejection was twice as common and infections frequent; Dr. Gill recalls patients who went “directly from the airport to the emergency room” due to severe infections or transplant failure.
In a similar study in Canada, where waiting periods for transplants are even longer, experiences were similar. Jeffrey Zaltzman, MD, reports infections common in the countries where the transplant was done were a big problem in medical tourists. One 78-year-old gentleman returned from Pakistan with a surgical wound that reopened spontaneously; he died a few weeks later of cardiovascular problems that might have disqualified him for a transplant at home. The cost to paid organ donors can be even greater. Poor people who sell a kidney, sometimes for as little as $800 according to the World Health Organization, face health problems like hypertension and worsening of their own kidney functions—provided, of course, that their surgery goes well. Since most live in countries where even blood pressure checks are rare, complications that develop after they leave the hospital may go undetected until it is too late for the patient. Donors in the United States frequently can have kidneys removed with very small incisions. Third World donors, however, generally end up with wounds up to 14 inches long that may take months to heal, making them unable to do the manual labor most depend on. Chronic pain and disability are common, points out Nancy Scheper-Hughes, who has extensively studied and reported on transplant practices from Brazil to China. And reports of organs coming from executed prisoners in China are even more worrisome. Details of where donors come from and which hospitals and doctors will do the surgery are rarely available to “clients” and their families ahead of time. While paying a donor for an organ is illegal everywhere except Iran, “international transplant coordinators” have no laws banning what they do—bringing clients together with hospitals in other countries. And as the WHO’s Dr. Luc Noel points out, “None of the brokers ever mention the costs—long-term health issues, chronic pain, inability to perform manual labor—that are borne by these poor organ vendors.”
SO THINK TWICE BEFORE FALLING FOR TRANSPLANT TOURISM. HIGH PROBABILITY YOU WON’T LIKE THE RESULTS!
“Atrial fibrillation, or AFib, is the most common type of arrhythmia.
It is a major cause of stroke, especially in the elderly. Although the causes are diverse, hypertension is common.”
AHA (American Heart Association)
Atrial Fib with Rapid Ventricular Rate
Working of the heart:
To easily identify atrial fibrillation with RVR, it is vital to understand the working of the heart. The atrium or atria (plural) is the upper chamber of the heart, bigger in size compared to the lower chambers known as the ventricles. The atria function by gathering blood as it flows into the heart and shrinking to forward the blood into the ventricles. At the very moment, the smaller ventricle must shrink to forward the blood to all parts of the body. This rhythm of blood flow creates a heart signature voice referred to as the Sinus rhythm. It is important that the sinus rhythm is synchronized so that the atrium does not send blood into the ventricle out of cue. To achieve this, an electric signal is generated to ensure the atrium contracts. When this signal short circuits (bypasses) the atrium, atrial fibrillation with RVR occurs, and the atrium is seen to vibrate just like jelly on a flat surface.
Atrial fib with RVR refers to atrial fibrillation with rapid ventricular rate. Usually the heart is like clockwork, the top (collecting) chambers beat then the bottom (main pumping) chambers sense this and also beat, and so on, in a nice regular fashion just like a clock ticking second after second. Usually the heart beats at about 60-80 beats per minute.
In atrial fibrillation the top chamber basically goes crazy often firing off over 400 beats per minute! Atrial fibrillation with RVR (Rapid Ventricular Response) is a heart condition caused by irregular electrical activity that results in irregular contractions of the 2 top heart chambers fibrillating. This means the heart (atriums), shakes with a rapid tremulous movement or makes fine irregular twitching movements, generally referred to as fibrillating causing little control in the heart output of blood by the heart but the lower chambers called the ventricles take over.
These bottom chambers don’t allow all those impulses through but it does let every second or third one through. This can give a heart rate of 100-180 beats per minute at rest, still too many beats, known as Afib with RVR, leading to symptoms and problems with heart function. Afib does not necessarily lead to Afib with RVR however, Afib can be rate controlled, sometimes naturally, sometimes using medications and sometimes requiring procedures as discussed below.
In most people with AFib although symptoms can sometimes be unpleasant it is generally not harmful as long as the afib is controlled, meaning the heart in the afib rhythm with the pulse under 100. The main concern is stroke, but that can be treated with the use of blood thinning medications in people at risk. In Afib with RVR, basically the heart is beating too fast. Of course palpitations are the most common symptom. Other symptoms of AFib with RVR may include dizziness, lack of energy, exercise intolerance and shortness of breath. If Afib with RVR goes on for too long then this may result in heart failure and of course worsening of existing heart failure. Control of the heart rate in patients with Afib with RVR often causes these symptoms to improve, again meaning the HR is under 100 with the heart rhythm in afib.
A major indication of atrial fibrillation with RVR is a very rapid heartbeat rate, although some patients are known to have the condition without showing symptoms. Atrial fibrillation with RVR may occur when cardiac muscle cells overcome their intrinsic pacemaker’s signals and fire rapidly differently from their normal pattern spreading the abnormal activity to the ventricles. The rapid heart rate can strain the heart, developing a situation referred to as Tachycardia (meaning a pulse greater than 100). Atrial fibrillation with RVR can be detected from the various symptoms though it is important to remember that some patients have experienced the condition without symptoms.
Symptoms:
Some of the symptoms of this disease include heart palpitations (described as unnoticed skipped beats or skipped beats noticed from experienced dizziness or difficulty in breathing), shortness of breath when lying flat (orthopnea), shortness of breath (dyspnea after exertion) sudden onset of short breath during the night (also called paroxysmal nocturnal dyspnea) and gradual swelling of lower extremities. As a result of inadequate blood flow, some patients complain of light headedness and may feel like they are about to faint, a condition referred to as presyncope and may actually lose consciousness (syncope). Some patients experience respiratory distress that results in them appearing blue. A close examination of jugular veins usually reveals elevated pressure in some patients (jugular venous distention). When some patients are subjected to lung examinations, crackles and rales may be observed pointing to possible lung edema.
Importance of proper diagnosis:
A good diagnosis of the symptoms shown by patients is important to ascertain that the patient is suffering from atrial fibrillation with RVR. This is because some forms or irregular and rapid heart rates, tachyarrhythmia, are dangerous and must be ruled out as they are life threatening – such as ventricular tachycardia. Some patients are usually placed on continuous cardio respiratory monitoring, but an electrocardiogram ECG is vital for correct diagnosis.
How is it diagnosed?
Simple, a typical 12 lead electrocardiogram (ECG). This test shows cardiac rhythms which atrial fibrillation is. Rhythms are made up of types of waves that the ECG shows which are P waves, QRS waves, T waves and U waves.
The QRS complexes should be narrow, to signify that they are being initiated by normal conduction of atrial electrical activity through the Intra-ventricular conduction system, or heart conduction system. Wide QRS complexes could point to ventricular tachycardia, although wide complexes may also be an indication of disease processes in the Intra-ventricular conduction system. The R-R internal will also likely be irregular. Meaning measuring from each R section of the QRS rhythm. It is also important to find out if there are triggering causes for the tachycardia which include dehydration, Hypovolemia – a decrease in blood volume, and more specifically decrease in blood plasma volume. You can go ahead to eliminate Acute coronary syndrome – which refers to any diseases that are directly attributed to the obstruction of coronary arteries.
WHAT IS THE TREATMENT:
A Shock
This is known as cardioversion and is used typically either when an immediate result is required or used when the Afib is of relatively recent onset or only intermittent, and so has more chance of staying in normal rhythm. In cardioversion a small shock is given using defibrillation pads. It is done under light anesthesia therefore it doesn’t hurt. The Afib may return however.
Rate Control Drugs
The biggest problem in Afib with RVR is too fast a heart rate. In a rhythm control strategy we use drugs such as beta-blockers to slow the heart rate down. These drugs typically will leave the patient in AF. For many people with AF it turns out that a rate control strategy is preferred as it is considered less risky than the rhythm control drugs used to get rid of the AF while being just as effective. In Afib with RVR rate control drugs can often slow the heart rate down fairly quickly and improve symptoms.
Rhythm Control Drugs
These medications are generally more powerful than the rate control drugs and attempt to convert the Afib back in to a normal rhythm. They are often given after a shock treatment to try and help the heart stay in normal rhythm. These drugs are also commonly used in hospitalized Afib with RVR patients. The problem with these drugs is that they may have side effects and associated risks. Many patients simply cannot tolerate Afib even if the rate is controlled and therefore require rhythm control drugs. They may be safe and effective however if used in selected patients. In cases of Afib with RVR these medications may need to be used if patients cannot tolerate other rate control medications.
Ablation Procedures
Ablation procedures are minimally invasive procedures typically done through the groin. They are typically used in patients that have tried, or cannot tolerate medicines for control of AFib. Ablation is typically not used as an emergency treatment of Afib with RVR, rather it is used for stable patients in AF, or those with intermittent AFib that wish to remain in normal rhythm. In patients that have had persistent Afib for a long time these procedures are not likely to be successful in the long term.
Pacemaker
This is typically the last throw of the dice for AF control. In some patients, drugs can either not control the rate in AFib with RVR, or the drugs can simply not be tolerated. In these patients who have no other choice, and in whom it is determined the Afib is causing harmful effects, a procedure called AV node ablation and pacemaker is done. In a relatively minor procedure, a small burn is made to the connection that connects the top and bottom chambers of the heart. A pacemaker is then inserted. This prevents Afib with RVR as although the top chambers continue to fire at a fast rate, the pacemaker now controls the bottom chamber, in a nice regular way. The downside of course is that now although the patient cannot have Afib with RVR, they have a pacemaker.
Acute afib RVR patients are more likely to be converted to Normal Sinus Rhythm (the best rhythm you could be in) as opposed to patients with chronic afib. There are complete resolutions for both kind of afib but atrial fibrillation in RVR the heart can handle for only so long and remembering the engine of our body is the heart so take good care of it for if you don’t it could allow you to die.
“The heart weighs between 7 and 15 ounces (200 to 425 grams) and is a little larger than the size of your fist. By the end of a long life, a person’s heart may have beat (expanded and contracted) more than 3.5 billion times. In fact, each day, the average heart beats 100,000 times, pumping about 2,000 gallons (7,571 liters) of blood.”
Texas Heart Institute
Lets review the anatomy of the heart, our bodies oxygen is the food to our tissues in keeping them alive through our red blood cells (RBC’s) that carry the O2 to the tissues through a heart and lungs working properly. The heart in pumping and the lungs in inspiration/expiration (one organ cannot live without the other).
There has to be a systemic way we allow this to work and this is through the heart, lungs, and RBC’s (3 systems that connect with each other). The heart = right side deals with more C02 blood than 02 blood which is blood returning to the heart to get more 02 going first via the Rt. side of the heart to the pulmonary artery, each of which carries blood to the lungs for 02 and C02 exchange to occur. This is for getting more 02 in our RBC’s with allowing them to release C02 at the lungs bases and then return to the left side of the heart. On the left side of the heart this is blood to be sent through both Lt. chambers (Lt. atria first and then the Lt. ventricle) of the heart to our blood stream to utilize the new 02 in our RBC’s that they intially obtained at our lungs going now to our body tissues. This is a 24hr/7days a week job for our red blood cells, lungs and heart in functioning to keep the human body alive.
In simpler terms this is how it works: The blood that needs to be refreshed with more 02 always which takes place by the blood in our body entering the right (Rt.) atrium coming from a vessel that brings back mainly carbon dioxide in the blood from the toes and the brain that was previously oxygenated blood that mainly was used up by the tissues and those RBC’s returning on the right side of the heart need to be reoxygenated with higher levels of oxygen. For the RBC’s to deliver 02 again to tissues in redoing this process all over again it goes through a pathway=our circulatory system. When the red blood cells need more oxygen it first goes to the Rt. atrium & fills up to its max level in that chamber to going to the Rt Ventricle than through the pulmonary artery to the lungs to get more 02. Simultaneously while the Right side of the heart does this the left (Lt.) atrium is filling up to its max level than goes to the Lt. Ventricle and out the Aorta to the arteries throughout the body to carry 02 to our tissues through the RBC’s carrying the 02. Ending line when the Rt. atrium is ready to drop its blood max level into the Rt. ventricle the Lt side does the same thing. The difference is the 02 and C02 content in Rt and Lt side of the heart (Right side is more C02 in the RBC’S whereas the Left side has more 02 content in the RBCs/blood.
For the blood to get to the atriums to the ventricles they have valves; they open between the chambers simultaneously (the tricuspid valve on the right side and mitral valve on the left side) dropping the blood to the lower chambers of the heart happens simultaneously but only the Rt. side ends up going to the lungs through a pulmonary artery to get more oxygen to send the highly oxygenated blood to the L (left) side of the heart. The job the Rt. side of the heart does this, it just goes from the Rt. side of the heart to our lungs and back to the heart on the Lt. side through the pulmonary veins to the L atrium than the Lt Ventricle going to the aorta this blood gets sent throughout the body; so the path or distance for the Rt. side of the heart to do its function is a short distance = it gets your used up oxygen in the red blood cells (that are high in carbon dioxide) to get more oxygen by going through the Rt. side of the heart sending them to the lungs where they get more O2 and then they are sent back to the Lt. side of the heart. This is the Rt. side of the heart’s function and explains why the heart muscle on that side of the heart is smaller than the Lt. side. Now let us look at what the Lt. side of the heart, in what blood it delivers to our tissues with our red blood cells (RBC’s). The RBC’s reoxygenated that leave the lungs and are sent via the pulmonary vein to the Lt. side of the heart, reaching the Lt. atrium, thus carries a high 02 level in the RBC’s (this blood just came directly from the lungs where O2 and CO2 exchange for the RBC’s took place). Next the RBC’s go to the Lt. ventricle to our Aorta that sends this high oxygen level of RBC’s out to all our tissues as food to prevent starvation of the tissues. Again, when the valves open between the chambers of the heart and allowing this blood to fill up in the lower chambers called the Rt. and Lt. ventricles it is simultaneously done. Also including the valves that open and close in the heart the pulmonary artery and the aorta or the tricuspid valve and mitral valve are simultaneous as well. The ventricle sending RBC’s out to our circulatory system high in O2 to be utilized by our body tissues is the Lt. Ventrilcle. To do this job takes more effort as opposed to the Rt. side of the heart and that is why the Lt side of the heart has a bigger muscle mass (more of a work out for that side of the heart).
So the way it works with both sides of the heart is the Rt. side sends blood of highly carbon dioxide blood (RBC’s) to the lungs to get re-oxygenated through 2 vessels from the Rt. side of the heart to the lungs that sends this re-oxygenated blood in the RBC’s through 2 vessels. On the Rt side of the heart you have the Superior Vena Cava which enters the C02 blood into the right atrium and the 2 pulmonary arteries that send that blood from the Rt Ventricle to the lungs to get the 0xygen from them. Than this blood goes to the Lt. side of the heart sends this highly oxygenated blood now throughout the top and bottom of the Lt. side of the heart through 2 vessels which are the pulmonary veins dumping the blood in the Lt atrium down into the Lt ventricle and out the aorta that sends this blood throughout our body tissues. When this oxygen is used all up from the RBC’s dispensing it out to tissues the C02 is taken back from the tissues by RBC’s that replace it with O2 through breathing; this process starts all over again with these RBC’s returning to the right side of the heart reaching the lungs to get more oxygen to be sent out by the left side of the heart to go out to all our tissues. Ending line the right side of the heart is for higher levels of carbon dioxide in the blood (used up oxygenated blood) to get more oxygen through our RBC’s whereas the left side of the heart sends higher levels of O2 throughout the body all the way to the toes through the RBC’s (a harder job on the left side of the heart=muscle mass of the left side of the heart works out more than the right making the left side of the heart a bigger muscle vs the right side).
Now knowing the anatomy and physiology of the heart let’s now understand more about a cardiac disease RVR=Rapid Ventricular Rate and Atrial Fibrillation and more regarding how they develop and in how it effects the engine of the body, being the heart, and the lungs=the transmission of the body. Like a car if the engine is affected in time the transmission gets affected and if not repaired by the mechanic the car engine will die with the transmission. Same effect with the human engine=the heart. If the heart is affected in time it will effect the lungs and if not repaired the heart will die and so will the lungs with the rest of the body.
Tomorrow Part 2 on Rapid Ventricular Rate and A Fib in how it affects the heart in functioning but how it can be treated to live a fairly normal life.