May I have some radiation, please?

Glaucoma is one of those diseases we encounter often in the prehospital setting, but don’t do anything about.  The reason is that glaucoma has a slow and gradual onset, and although detrimental to the patient, it is a condition that does not affect airway, breathing, or circulation, and therefore, does not become of much concern to prehospital providers.  We are actually only concerned with knowing which medications we administer that has glaucoma as a relative contraindication.  Since glaucoma is a disease that affects more than 4 million Americans, and is the leading cause of blindness, it is an important possible contraindication to keep in mind.

However, this blog is not about basic facts. It is about interesting concepts!  So let me tell you about some new discoveries concerning glaucoma.

First, researchers have figured out that in response to early stresses on ocular tissue, endothelial cells that line the blood vessels of the eye allow the entry of immune cells known as monocytes into the optic nerve and retina, which end up expressing molecules that damag the nerves—causing glaucoma. The good news is that other researches have figured out a way to prevent this from occurring.

The first hint came from Hiroshima survivors, who, although experiencing countless other health problems from the radiation exposure, tended to not develop glaucoma.  And a decade ago, researchers discovered that a single dose of whole-body irradiation seemed to provide protection against glaucoma.  Now, scientists have discovered that localized and targeted radiation exposures to the eyes of mice that tend to develop glaucoma, provides lifelong protection against this disease. The idea is that radiation changes how those endothelial cells respond to those early tissue stresses and reduces the entry of monocytes into the optic nerve and retina. No monocytes, no glaucoma!

How about that!!!

Where have you been?

My back injury has improved enough for me to return to light duty.  This means I had to tackle a number of projects and rearrange my schedule to accommodate "regular" work hours.  Not an easy task when you are used to shift work, and have a family life  build around the fireman schedule.


I will be back to "normal" full time status soon (I hope), and then I should have time to resume my blogging endeavor.  I have missed it ... almost as much as I have missed working these streets.  Until then!


... How about that!

Alzheimer's disease

Do you want a quick lesson on Alzheimer’s disease?  Just understand this, Alzheimer’s is characterized by loss of neurons in the cerebral cortex and certain subcortical regions, resulting in gross atrophy of the brain.  A part of your brain, called the hippocampus is involved in memory.  Specifically, the left hippocampus is involved in forming stories of your life from bits and pieces of your experiences.  It will form the neuronal impulses describing how you view yourself.  Basically, it forms the internal autobiography of who you are.  Alzheimer’s takes this away.

Combination of two brain diagrams in one for comparison. In the left normal brain, in the right brain of a person with Alzheimer's disease.

Source: http://en.wikipedia.org/wiki/File:COMPARISONSLICE_HIGH.JPG

Unlike other neurological disorders like schizophrenia or hallucinations where your interactions should be focused on bringing the patient into reality, when treating an Alzheimer’s patient, you have to enter “their world” and interact with them “there.”

Preach Heaven...

This past month we celebrated Saint Valentine’s Day.  A little known fact about Saint Valentine is that he is not only the patron saint of love, he is also the patron saint of epilepsy.  Legend has it that St Valentine miraculously cured a young woman afflicted with what is now thought of as epilepsy.  Another interesting correlation of religion and epilepsy is a seizure disorder originating in the temporal lobe that causes hyper-religiosity.


I learned about this disorder from a book I have mentioned many times – Incognito.  In it the author describes epilepsy as such: “…the long list of influences on your mental life stretches far beyond chemicals – it includes the details of circuitry, as well…. If an epileptic seizure is focused in a particular sweet spot in the temporal lobe, a person won’t have motor seizures, but instead something more subtle.  The effect is something like a cognitive seizure, marked by changes of personality…”


Any provider knows to use caution with patients in the postictal state.  I cannot recount the number of violent outburst I have personally had to deal with from combative postictal patients.  In conclusion:  I rather have someone preach heaven to me, instead of beat hell out of me.


How about that!