Just Noticing: “Observations Of A Blogger”
Posted by Michelle Moquin on September 18th, 2011
Good morning!
”Just noticing”….while on a walk with Lucy...
Readers: My wishes as well.
Mike: Ya know what..I can’t just “forget it”. That would be giving up. I just can’t give up on the president, and I can’t just give up on our country. I realize the republicans won’t do shit to support him, and in fact will do everything in their power to stop him form being successful.
I don’t care what white America wants. There are plenty of Americans that want him to succeed and we just have to keep at it. But if I give up, and we all give up, we’ve lost, and they’ve won. So I can’t just say “fuck it and forget it”. Readers who have been around long enough know this about me. I refuse to lose to a party that cares more about seeing Obama fail than seeing our country flourish.
Robert: I wish there was an “or what?”, but there isn’t. We’re stuck with the sociopaths.
Peter: And how long have they been doing this until they discovered it “made no sense”? How many other stupid things are down with our tax dollars?
David: I love your comment. Have you told your sister that?
Zea: Please clarify what you mean when you say, “….these people don’t deserve this place”. Do you mean the women don’t deserve the City of Joy? And if so, why would you say that?
Betty: Thanks for posting about The Women’s Wilderness Institute., and particularly the program for America’s female veterans. I had not heard of that organization nor the program, but it is certainly needed and I HOPE does the women good.
Irene: Yes, I have noticed. And to answer your question with respect to your husband, he doesn’t want to tax the millionaires because he thinks that someday he is going to be one of those wealthy millionaires - He doesn’t realize that he never will be.
May peace prevail on Earth…
Lastly, greed over a great story is surfacing from my “loyal”(?) readers. With all this back and forth about who owns what, that appears on my blog, let me reiterate that all material posted on my blog becomes the sole property of my blog. If you want to reserve any proprietary rights don’t post it to my blog. I will prominently display this caveat on my blog from now on to remind those who may have forgotten this notice.
Gratefully your blog host,
michelle
Aka BABE: We all know what this means by now :)
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September 18th, 2011 at 2:01 pm
HOW TO SURVIVE A STAY IN THE INTENSIVE CARE UNIT
If we’ve learned one thing about hospital care in recent years it’s this — being a patient can be more dangerous than whatever medical problems you already had!
It’s one of those perplexing ironies, but the intensive care unit (ICU), in particular, can be destructive to one’s health and well-being.
As many as 80% of patients who have survived a critical illness that required a stay in intensive care paid a price. While recovering from the immediate problem — such as a heart attack or pneumonia — many patients develop cognitive problems, for example, trouble with focus and concentration.
They may also have difficulty performing simple, everyday tasks and experience a decreased quality of life, and once they’ve left the hospital, they may find themselves unable to return to work.
In some cases, individuals continue to feel these ill effects up to one or two years later… and for an unlucky few, the impact is even longer term.
Memory and thinking difficulties after a stay in the ICU can make it seem as if your brain is stuck in molasses, observes E. Wesley Ely, MD, MPH, an expert in critical care at Vanderbilt University School of Medicine.
Now he and his colleagues have designed a five-step protocol to improve care and outcomes for ICU patients. Since Daily Health News has reported on some of these proposed innovations in the past (Daily Health News, December 7, 2010), I’m glad to see that they actually are being put into practice.
THE CODE: A-B-C-D-E
At Vanderbilt, Dr. Ely and his colleagues have devised what they call the A-B-C-D-E model of care:
Awakening (stopping sedation)
Breathing Coordination (stopping respirator)
Choice of Proper Sedation
Delirium Monitoring
Early Exercise and Mobility
Some four out of every 10 US hospitals have already introduced at least some of these steps, but the guidelines are basic enough that family members can check to see if they’re being followed.
(Note: This is a key reason why it is so important to stay with a loved one during a hospitalization.)
YOUR ROLE IN THE HOSPITAL
Here is what you can do to make sure that caregivers know their A,B,C,D,Es and that you or your loved one gets the best possible care in the ICU…
WAKE PATIENTS AT REGULAR INTERVALS
Many hospitals now make it a habit to wake sedated patients and those on ventilators to see whether they can breathe on their own –
the idea being that the earlier that breathing tubes and ventilators can be removed, the lower the risk for delirium and subsequent cognitive difficulties.
But the flip side of this guideline may be equally important — hospitals should let patients sleep through the night whenever possible!
As many of us know from personal experience, sleep is often the casualty of a hospital stay.
Caregivers should wake patients a few times a day, and if they’re sleeping through the night, leave them be.
GO LIGHT ON THE SEDATION
Like sleep deprivation, heavy and prolonged sedation can cause or worsen delirium. Some sedatives (such as benzodiazepines) are more likely than others to produce delirium, but Dr. Ely emphasizes that sedation is not a one-size-fits-all proposition and must be carefully individualized.
A good approach, Dr. Ely says, is to ask your physician to use the lightest possible postsurgical sedation — a level that effectively relieves pain but still leaves the patient’s mental state as intact as possible.
GET OUT OF BED
Most ICU patients should move around as much as possible because we now know that immobility leads not only to loss of muscle strength and increased frailty, but also a higher risk for confusion and delirium.
ICU patients can often receive physical therapy that helps them stay limber with range-of-motion exercises.
When patients are able, it’s good for them to leave the bed and sit in a chair (with help of course) a few times a day and eventually work their way up to a walk down the hall.
WATCH CAREFULLY FOR SIGNS OF DELIRIUM
It’s vital to make sure that the doctors and nurses are watching for signs of delirium (and loved ones and family members should also be closely attuned for telltale signs) because the longer delirium persists in the ICU, the greater the likelihood of later cognitive impairment.
To catch delirium early on, doctors and nurses (and you, too) need to check patients for such early signs as inattentiveness —
for instance, the inability to stay focused or follow a command for 10 seconds (such as being able to squeeze the nurse’s hand every time she says a word with the letter “A” in it).
If confused responses suggest delirium, your physician can take prompt steps to control it, including cutting back on sedatives…
helping the patient to get out of bed and move around (with appropriate assistance)… removing physical restraints and catheters… and allowing him/her to sleep through the night by performing only nonintrusive monitoring of vital signs.
IF YOU SEE SOMETHING, SAY SOMETHING
ICU patients are very sick, typically not well enough to advocate for themselves, which means it’s up to family members and close friends to step in and fill the breach.
Dr. Ely advises that you do this by keeping in very close touch with the patient’s medical team.
If you notice, for example, that your mother suddenly seems “not herself” — even if there are no obvious signs of delirium — tell her physician right away and bring up the possibility of early delirium.
Dr. Ely says that alerting doctors is half the battle and can unquestionably lead to better, happier outcomes all around.
The new model, he hopes, will make ICU care much easier — almost as simple as knowing your A,B,C,D,Es!
Source(s):
E. Wesley Ely, MD, MPH, professor of medicine, Vanderbilt University School of Medicine, Nashville.
He is founder of Vanderbilt’s ICU Delirium and Cognitive Impairment Study Group and the associate director of aging research for the VA Tennessee Valley Geriatric Research and Education Clinical Center (GRECC).
September 18th, 2011 at 2:10 pm
261
No. 261 of 365
Say to a liberal, “You remember the Reagan era, when Ronald Reagan was President, and Bob Hope and Johnny Cash were still with us?
Well, now we have Obama, no hope, and no cash.”
September 18th, 2011 at 5:27 pm
Hi MIscha, great Eve article and TED video, thanks for that.
Holly, how you put my name with your own bigotry in the same comment directed at me is totally beyond me…
Misch, I had the same q for Zea.
Luv, Zen LIll
September 19th, 2011 at 7:18 am
Holly, I agree with Zen Lill. What change are you being? You are willing to remain a part of a party to get the “N” out. Disgusting!
How would you like it if the OTWs of America referred to the other 43 white male presidents with a racial slur? Disagreeing with someone’s politics is one thing to carry it into racial epithets is hateful.
Who would care about your selections if you are basing them on race, but the same type of people you claim to find fault with.
Patricia
PS. Michelle many may find fault with your refusal to censor your blog. I think this kind of exposure permits all of us to see the world in its true light.
September 19th, 2011 at 7:25 am
I will support Obama but I read this today in Huff. I think it says were Obama needs to start to get the people who he has lost back.
===========================
We don’t know yet what the overarching theme of President Obama’s reelection campaign will be, but the word “change” is likely to once again play at least a co-starring role. But this time it’s different.
We’ve now seen the ways in which the president went about trying to effect that change over the last three years.
So while his ideas about the changes the system needs in his second term are welcome and necessary, there is another kind of change he needs to talk about if the change he proposes is to be believed.
He needs to make clear the changes he intends to make in himself, in the way he governs, and in the way he approaches the big, systemic changes he claims to want to see.
In order for voters to believe that things will be different in the president’s second term, there has to be some recognition of what didn’t work in the first.
==========================
I think Obama needs to acknowledge that he made a mistake thinking the republicans really wanted to compromise. He needs to say that this time he will push he agenda without trying to compromise in the face of total refusal by the republicans. He needs to say that he will take his proposals on the road and let the people decide.
Renee
September 19th, 2011 at 7:40 am
Renee;
I read this about 3 hours ago before I headed for work. “Right now, Warren Buffett pays a lower tax rate than his secretary — an outrage he has asked us to fix. We need a tax code where everyone gets a fair shake, and everybody pays their fair share.”
How difficult for Obama to march on this? I am not supporting him until I hear that he will not give in to republicans and allow them get the increase for social security to go from 65 to 67.
Those lap dogs for the rich are hoping that many will die in that wait for social security during those 2 extra years so they can give that money to the rich in the form of subsidies.
I say if Obama can’t decide whether he wants to be a democrat or republican then he will not get my support.
Wendy
September 19th, 2011 at 7:53 am
Ditto with me on what Obama has to do. If the republicans think they can convince most of America that we have to accept paying more tax on our incomes than our bosses do so that we can get a job, let them bet on that horse.
But Obama needs to define that as the bet. He allows the republicans to make completely idiotic and historically false assertions without getting on them in force.
When Paul Ryan told Fox noise that Obama’s proposed tax “adds further instability to our system, more uncertainty, and it punishes job creation.”
Obama should have immediately applied the truth to that deliberate lie.
Tax rates on the rich were higher during the Clinton years, when the economy was booming, and higher still during the long post World War II boom, when the economy grew at nearly 4 percent per year for better than two decades and the great blue collar middle class was built.
The public needs to know that the republicans will tell any lie to win support. But they can only know that when truly informed. I have many coworkers who still spout that “the republicans are fiscally conservative” crap.
It’s easy for them to believe in a few fancy words because no one is countering them with facts.
Herman
September 19th, 2011 at 8:14 am
Herman, thank you for that advice that I hope Obama takes to heart. He needs to define the difference between what he has to offer and what the republicans are proposing.
The republicans are the ones who once they get there president in the White House, they manage to stay the full 8 years to totally screw up the economy and the judicial system of this country. Only the first Bush didn’t get a second term for the republicans.
But most democrats are unaware that they haven’t been able to give their presidents a two term period in the White House since Roosevelt did it back in 1945, except for Clinton. Obama is up against the odds in more ways than one. Democrats have a long history of not giving their presidents a second term.
The republicans usually figure out what to tell the white voters to get their vote the second time if they lost them the first. So they seem too have this time. Race being another stone Obama has to drag isn’t helping either.
But as Herman said Obama needs to define who he is. And as Wendy said he needs to stand up for the class who’s side he is on in this war. There was another quote from Buffet cited in that article by Robert Kuttner that I read yesterday Obama should be quoting as he campaigns across the country.
He should quote Buffet when he once said of class warfare that there was indeed a class war in America and his class, the very rich, were winning.
Robert
September 19th, 2011 at 9:00 am
OMG, Michelle, you are in that man’s head. He is always telling anyone who will listen of his plans to make it big.
September 19th, 2011 at 9:07 am
I enjoyed your link Zen Lill, about the “Junk in the Trunk.” I sent it to my best BFF, Toni. She has aways been vocal about her big ass. She used to say “you white girls are gonna have to stop hiding your big asses with those sweaters one day.”
Boy was she right. Now we are even adding silicone to increase them. We went to the mall together yesterday laughing and pointing out the ones who have gotten the message that ass is in and those still a little ashamed of their “Junk.”
So much fun was had by all. Thanks Zen Lill
Katt
September 19th, 2011 at 9:11 am
Hafa adai Michelle,
Many of my friends on Guam called to give me the answer to the question. The consensus seems to be it started with Bush along with his regulations that made sending things to Guam so difficult for the mainland.
The extra cost and paperwork has made fortunes for those in the business of suppling the paperwork to send a package to Guam. If only the American tax payers knew.
Peter
September 19th, 2011 at 9:19 am
WHEN IS IT SAFE TO DRIVE AFTER A STROKE?
How high on the list of difficult conversations is this one:
You’re an adult having to tell your mother or father that he/she shouldn’t drive anymore… or a spouse having to give your wife or hubby the same message.
This is often the case after someone has had a stroke… which doesn’t make the conversation (or the decision about whether continued driving is safe) any easier.
But I’ve come across an interesting new study that I think may offer some real practical help in easing you through that tough conversation.
Belgian researchers have identified a series of three relatively simple tests — soon to be available in the US.
Once that happens, taking them should be quite easy. The estimated time needed is only 15 minutes.
The tests can identify who would and who wouldn’t be likely to pass a typical driving road test — a good (but not perfect) indication of who would be a safe driver after a stroke.
Besides sparing you from a wrenching argument with a hurt, defensive and very possibly angry parent or spouse, this might also spare the stroke survivor from having to try to prepare for and get through an official road test — as they may be required to do after a stroke — and ultimately fail it.
HOW SERIOUS WAS THE STROKE?
Before we get to these simple new tests, the first thing to know is that for many people, driving is still safe after a stroke — depending, of course, on the amount and type of damage done and the success of rehabilitation therapy.
To find out more, I checked with the lead author of the study, Hannes Devos, PhD, PT, in the department of rehabilitation sciences at the Catholic University of Leuven in Belgium.
“Much depends on the area of the brain that’s affected,” he explained. If the stroke took place in the temporal lobes, which are key to the ability to perceive and understand information, a stroke survivor might see a street sign and be able to read the words… yet not know what they mean.
If it’s the occipital lobes, which receive and organize input from the eyes, that are affected, then vision might be impaired.
And if the stroke occurred in the frontal lobes, where higher organizational function is maintained, then judgment, problem solving ability and motor skills — all obviously vital to safe driving — might be lacking.
Making things even more difficult is the fact that some stroke patients are not aware, or not fully aware, of their deficits, Dr. Devos added.
“For example, they may think that nothing serious is wrong with the way their body works even when muscles on one side of the body are barely working at all, so they don’t comprehend what’s dangerous or what must be avoided,” he said.
Unfortunately, strokes can be cruel that way… so what I wondered about the new study was, how could all of this — the physical and the psychological — be sorted out in just 15 minutes and tell us who should and who shouldn’t be driving?
HOW THE TESTS WORK
Out of the 1,728 people studied, 54% passed their road tests, the best determinants of success being the following three tests…
The road sign recognition test. In this segment, the person being tested is asked to match 12 road signs, where their meaning must be recognized and matched to cards showing particular driving situations —
for example, they might have to match a road sign indicating construction ahead with a card “depicting” men repairing a road.
The compass test. This is a test of perception, attention and mental speed that involves placing cards with “vehicles” on them so that the vehicles are lined up properly according to the directions indicated on a second card —
a compass with an arrow showing various directions. This tests the ability to understand directions consistently and under pressure.
The trail making test part B (TMT B). In this segment, participants are asked to quickly connect circles containing numbers or combinations of the numbers one to 12 and the letters A to L, as in 1-A, 2-B, 3-C.
What’s measured here are visual motor abilities and the ability to shift one’s attention.
The tests aren’t perfect, but the authors of the study say that they can correctly identify 80% to 85% of those tested who would make unsafe drivers.
Importantly, the tests failed to identify 15% to 20% of unsafe drivers — and researchers point out that they may also fail to identify some safe drivers, as well.
But post-stroke road tests could make up these gaps.
For families who are sure or fairly sure that driving should no longer be an activity for a loved one, these tests can be a big help in terms of satisfying everyone involved that getting behind the wheel is just no longer a good idea.
Dr. Devos says the tests will be available in the US in the very near future and that physicians, neuropsychologists and occupational therapists will be able to help obtain and administer them. I’ll keep my eye out for them.
Source(s):
Hannes Devos, PhD, PT, department of rehabilitation science, Catholic University of Leuven, Belgium.