#as the one who had the emergency needs 24/7 care during recovery but is being released from hospital to recover at home

[thevioletcaptain]

.

[anitacoknow]

I'm feeling my emotions pretty hard today (June 14th, 2021), so it might be a good idea to start writing.

Trigger Warning:

This text post mentions suicide, death, abortion, and could be an uneasy read.

About two months ago, I almost died during a routine abortion. The way that sounds, my stomach turns and it makes the tears fall like a monsoon. Nothing about getting an abortion is easy, it is humiliating and it's a huge personal hurdle to deal with - my heart goes out to any woman who has been in that tough position. That being said, I'm not writing this for sympathy nor am I looking for negative comments or death threats, I put myself through that enough already with my own mental.

Starting this attempt to release my emotions is difficult because I'm not even sure what to say to myself. I guess I am also hopeful someone will have the right words through experience or just in general because I'm struggling to find the words within myself.

To begin, I can't have children anymore and that is the worst part; I made a decision that took future decisions, future generations, future plans away from me. So, to anyone who wanted to go in on me at the sight of the word abortion: fate ironically beat you to the punch.

I made a decision that my heart wasn't wholly in and it almost cost me my life and it cost my daughter's life (I don't need scientific fact proving she was just a clump of cells and hadn't begun processing pain or emotion or whatever, doesn't change shit as far as empathy goes, so please shove it).

Her birth name was to be Juniper.

To give some insight, Washington State allows abortions up to 28 weeks. For those who aren't aware of pregnancy cycles/trimesters, 28 weeks is still half way through the pregnancy and the beginning of the second trimester. The fetus during this stage has become more human like and all that science stuff. I had my abortion at 21 weeks, in a clinic and the process shouldn't have gone the way it did.

On the second day of my procedure, I was put under anesthesia and when I woke up I wasn't all there. Before this, I had never experienced being put under anesthesia to my recollection, so what I thought I was feeling was normal. It wasn't until I realized I had been losing conciousness that things started to feel unnatural. I was laid on the floor of the "recovery room" and I started to regain conciousness fast. There was a lot of blood between my legs and mentioning it to them seemed to make the blood pool more. It wasn't long after that the doctor that performed the procedure squated next to me to tell me she needed to put me back under.

For the next bit, I apologize to the squeamish.

There was another woman in the room with me who had just come out of her own anesthesia, she was ironically a CNA, who started to show signs of worry when I wasn't making the anticipated recovery. The doctor had her removed from the room and leaned back in to tell me that they couldn't locate the fetal head and a few limbs. When they attempted to have me walk back to the room, I fainted and was placed back on the floor. The nurses wheeled me into the surgical room and helped me back on to the table, to which I protested them allowing me to see my ride. I'm hesitant to mention the father in this because it is sensitive, so I apologize for how he is mentioned in further comments. It wasn't until I saw him that things started to blur and I started losing conciousness again.

I feel it is also important to explain what I felt, which was extremely cold. My nipples were harder than they had ever been and despite the numerous blankets, warmed and otherwise, that were placed on me, my body didn't feel warmth until the EMTs carted me to the ambulance and the sun touched me; and again when I was placed on the surgical table at the hospital. Mentally, I don't think I was aware of anything bad happening to my body. Even after hearing they lost the fetal head, I don't think I ever reacted. If I had to say, I was mentally blissful - which isn't something I have ever experienced. I literally couldn't care less, everything was a joke (which is also part of my personality when dealing with assumed stressful situations) to me up until I arrived at the ER and they put me under before telling me that they might have to remove my whole uterus. My last words would have been: "oh, this table is so warm!" to the doctor who saved my life. When I woke up 24 hours later, there was a tube in my throat and I was tied to the bed (which Hollywood doesn't show in movies or T.V. so when you are experiencing it, it is really scary and it fucking hurts.) in ICU.

So, what the fuck happened?

Well, my uterus at the time of the abortion was about 2 pounds heavy and 2 feet long; Juniper was about the size of a sweet potato to give you an image. During the abortion, the doctor perforated my uterus, the length of the tear was about a foot long according to my surgeon/aftercare doctor. The abortion itself was supposedly no more than 10 minutes, but I was apparently under for roughly an hour. My ride expected me out in two hours, but after speaking to him, started to worry when I hadn't responded to texts and the elapsed time came to four hours. During the removal of the fetus, after perforation had occurred, I laid there internally bleeding for several hours. The human body can hold minimum 5 litres of blood (or to give you an physical idea, a gallon [US] of milk about) depending on the size of the body and health. A human can die from losing 2 litres of blood, but I survived after losing 4 litres internally, which is probably what saved my life. I vaguely remember being lifted on to the gurney and I vaguely remember the ride to the ER. I was given 7 units of blood, my uterus was stitched in 8 layers and the fetal head had nestled itself behind my kidney, so I had an emergency cesarean, plus a JP drain placed to remove all the blood that pooled in my abdomen.

The hospital experience itself is a different story and makes the whole ordeal just as sad. The only solace I had were two nurses that really didn't judge me, outside of that, everyone there had an opinion and wore it on their face and in their treatment. My last interaction with one of the doctors who helped performed my "miraculous" surgery and was probably the most surprising bit because it included a little racism. My partner is white and he is cisgender. Before his appearance, said doctor largely made fun of my pain tolerance when removing surgical tape from my incision area and inner thighs. If you haven't had a cesarean or don't know exactly what it is, after making the initial incision, the doctors have to literally tear the muscles apart to get to your uterus. In my case, I also had to have my intestines removed to get to my kidneys. Needless to say, my midsection was very sensitive outside of my low pain threshold. During the stint, he very angrily asked me if I wanted to remove the bandage myself while showing his frustration in his whole body and face. At that point, I just said fuck it and let him tear the bandage from my body with a little skin along with it. After a quick look, he stood up and asked if I cared if he left to deliver a baby and he didn't wait for a response, I assume because my face probably said exactly what he wanted. I sat there and cried until my partner got there and when he showed face again, his bedside manner gave me whiplash. He released us after I made a large fuss about my care and I left holding back tears until we were out of sight of the hospital.

The day before I almost died, I sat with the owner of the clinic who also doubles as a nurse there, and cried to her about my fear and the little consolation I had because she was kind. I have had two previous abortions during a previous marriage that I also didn't want to have, but being in an abusive relationship, you give and take a lot, that included. I confided in her that those two experiences, both at Planned Parenthood, were riddled in racist bedside manner and left me uneasy about abortions and clinics in general. Being a woman of color herself, she cried with me and assured me that things would be fine, in fact the woman doing my abortion would also be a woman of color. She called me two days later, I could hear her sadness, but it also left me in such a state of panic that I ended the conversation without saying much.

Women of color do not have great mortality rates when it comes to medical intervention, especially during pregnancies/child birth. However, uterus perforation during an abortion only occurs at a rate of .3%, so I'm part of a medical anomaly (it isn't an anomaly at all, she just fucked up). Beyond that, women of color, specifically black women are more likely to suffer from medical racism during aftercare. One of the biggest glaring problems being that black women are percieved to have a high pain threshold, something a lot of people lack.

Since this experience, which is missing a lot of detail, I've gone in an out of depressive mania. Which, to say the least, I can handle because I've dealt with it for years. What I can't handle are commercials, or even cherub faces in person, or the fact that my step-sister announced her pregnancy to our parents on mother's day. I can't handle the notifications of memories from my pictures that spotlight some of the photos I took during my pregnancy. I can't handle that my neighbors had just moved in and had just given birth right before being released from the hospital. Movie montages about children growing up making lumps swell in my throat. For the first few weeks I would wake up screaming, or crying, or begging whoever not to take my baby from me. I tried to cope with sex that I couldn't realistically have because I was healing. I took up smoking cigarettes again because it is the only thing I could physically feel relax my incision area. My daughter, who is 9 years old, asks me how I'm doing when I don't realize I'm zoned out and crying.

Overall, I wish they would have let me die. It isn't like I haven't tried to kill myself before and I always secretly hoped I'd find a way to just go peacefully. Of all my attempts at suicide, the most serious was drinking bleach and all I got from that was minor chemical burn in my esophagus.

Sitting there during my last follow up, knowing damn well I wasn't going to get good news, I asked the doctor who saved my uterus and life if I could safely get pregnant. I was told by another I could have a child, but it would most likely be harrowing because my uterus wouldn't be able to house a full term fetus and they would most like be born premature. There was also another possibility she kept from me, which my doctor with a penchant for being very frank said: "would end up taking my uterus or almost killing me."

Word for word: if I get pregnant, my uterus would rupture at the healed incision.

And what, what am I supposed to think or feel now that my worst fear finally materialized? I'm realistically mad at myself for materializing my greatest fear. I also hate myself for being so upset at something I caused because I know others are in my situation for reasons beyond their control.

I thought writing this would make me feel better, would make it so I wouldn't have to mentally relive it, but I just feel worse. My partner lost his job because he took a leave of absence to take care of me and that's to say nothing of him taking time off at the beginning of the year because he needed brain surgery. The job I had interviewed for earlier in the week kept my position open, but on returning to work found I couldn't keep my anxiety to a minimum and eventually asked for leave of absence. So now, we are struggling financially and I blame myself for that too, which I know I shouldn't.

I can't begin to explain how unsure and confused I feel every day. Some times I find myself pacing or walking around and I don't even know what I'm doing. Hearing or seeing emergency vehicles makes me panic. I've had to force myself to look down during driving because I'm so fucking scared.

Idk, I'm sorry to whoever is reading this. I just needed to vent.

[fertility-journey]

Birth Story

We tried many natural labour inductions methods to support our due date of Wednesday 24 March including; x3 acupuncture, x2 shiatsu massage, sex, long walks, raspberry leaf tea, dates, prune juice, and spicy food.

We gave birth to a beautiful healthy boy at 7:29pm Saturday 3 April 2021 (Easter weekend) weighing 3.27kg and measuring 51cm.

Our hospital offered us a debrief session with the head nurse and potentially obstetrician.

Short version

Having done a stretch and sweep earlier in the week on Monday at 1cm dilated, we were admitted to hospital on Friday evening to commence induction with prostaglandin gel. On Saturday morning in the birthing suite my waters were broken and oxytocin commenced an hour later since I hadn’t progressed beyond 1cm dilation. I was administered an epidural so I wouldn’t feel the contractions but knew they were happening via being hooked up to an Electric Fetal Monitoring (EFM) machine. I progressed to 4cm dilation and later 8cm dilation however each vaginal exam caused baby’s heart rate to drop. This called for an emergency caesarean as it was later found baby’s head was swollen and in malposition slightly transverse. The operation caused a postpartum hemorrhage (PPH) on my uterus where I lost over 1L blood. After being wheeled into recovery, I was then able to have baby placed on me for skin to skin. Once back in the room, drugs had worn off and I could feel one slow contraction for approximately 1.5 hours which was the worst pain of my life. The days following the birth was all about recovery and breastfeeding. I had two units of blood transfusion and iron infusion to try restore my hemoglobin levels which were halved. I had managed to stand up in the shower, do a poo and by the end of the week, walk down the hallway. Breastfeeding is a challenge with no milk supply so there were many discussions about progress each day and using donor milk and formula through supplemental devices to avoid bottle feeding. We were ready to head home Thursday morning after being in the hospital for almost a week. I cannot appreciate enough having flowers in my room since I didn’t leave it for days!

Long version

On Monday 29 March being 40w5d we went into the birthing suite to do a stretch and sweep. This was very uncomfortable as I squeezed my partner’s hand and looked into his eyes. One of the midwives was helpful in reminding me about hypnobirthing breath. Our obstetrician advised that I was 1cm dilated so hopefully baby would arrive soon. The midwife showed us a stretch to help relax my pelvis.

Our obstetrician wanted us back for induction on Wednesday or Thursday because of Easter weekend however we asked to push it out until Saturday.

On Friday 2 April being 41w2d we were admitted to hospital at 4pm to be given prostaglandin induction gel at 6pm. An electrical fetal monitoring (EFM) machine is used before/during/after. This was done in our private hospital room by a midwife and was once again very uncomfortable/painful. I was still only 1cm dilated. A different midwife returned at midnight for another treatment.

The following morning, Saturday 3 April being 41w3d we went to the birthing suite to receive a final treatment of prostaglandin induction gel by the midwife at 6:30am. This time I used a small amount of gas to ease the pain. There had been no change in my dilation.

Later, around 11:30am our obstetrician came in and broke my waters. I used the gas at a higher dose to ease the pain where I saw psychedelic colours for a brief moment. We thought we’d have time from here to continue waiting for labour to occur but was informed we’d start oxytocin within the next hour. It was suggested we go walk up and down some steps outside but was influenced to get an epidural. We had written in our plan that we don’t want this suggested and if we wanted it, we’d ask for it. So since they did suggest it, I thought I mustn’t be handling the pain well from the other procedures. I also thought that this was maybe a call to surrender and go with the flow. We had no time to go do stairs since the anesthetist was already in the hospital nearby and everything had to be set up ready to go on me for him to perform. We later found out that we shouldn’t have been rushed into this decision because the anesthetist is on call and could’ve simply come back.

The anesthetist ended up coming in later so there would’ve been time to walk a few stairs. He gave me the epidural which hurt and the midwife attached a catheter. This now meant I could not get up and leave the bed and would have the EFM constantly on. One of the side affects was feeling itchy across my chest.

The oxytocin could then commence to try start contractions. I couldn’t feel contractions since I’d had the epidural but the EFM showed I was. I was getting very shakey as a side effect but because of the calm environment, I could use my breath to suppress the shakes and try send baby downwards.

A different midwife started the next shift who was caring. She did a vaginal examination which I didn’t feel because of the epidural and said I was 4cm dilated. Moving into the evening, I had reached 8cm dilation with our obstetrician performing another two vaginal exams. Each time, baby’s heart rate would lower from having his head touched.

The song ‘Waiting’ by Kian started playing from my labour playlist. I said to my partner ‘how about the name, Kian?’. A quick google showed this meant ‘grace of god’ in Sanskrit, ‘ancient’ in Irish, and ‘king’ in Persian. All beautiful meanings which were discussed under fake candlelight in our calm birthing suite.

Now at approximately 7pm, our obstetrician made the call to do an emergency caesarean due to baby’s erratic heart rate and the fact I hadn’t progress from 8cm dilation. Everything changed quickly from here as a few extra people entered the room and I was maneuvered onto a different operation bed.

I was being wheeled to theatre and when arriving on the floor, met by a different anesthetist who was saying lots of disclaimers including that this operation could result in death - just what you want to hear. I required some further drugs for the operation so she was testing that I couldn’t feel the cold ice packs being placed on my body. She commended me on how calm I was or doing a good job at faking it! I was very conscious about remaining as calm as possible to ensure things could go as smoothly as possible.

It was exceptionally cold in the theater with many people in the room since everyone has an assistant. My partner was getting changed into scrubs and allowed to enter seated beside me once everything was set up. Coldplay was being played on someone’s phone.

Though probably only 15 minutes, it felt like a long time having the operation to retrieve baby. He came out safely and my partner got to announce he’s a boy. When I saw him I just said ‘oh my god’. He arrived at 7:29pm weighing 3.27kg and 51cm long. He had a swollen head which has been in malposition slightly transverse and had tiny cut on his eyebrow from the surgery tools. I had the opportunity to give baby a kiss.

From there things changed further, the cold had caused my shaking to dramatically increase and I couldn’t control it with the same breath I’d been practicing for hours in the birth suite prior. I was given some drugs to suppress the shaking and then the side effects of this was that I started vomiting. Because all this was happening, I didn’t have the opportunity to engage with baby as I needed to focus on myself. Warm towels were placed around my head.

My partner was able to look at the placenta which had a short umbilical cord which could also be a reason why baby wasn’t coming out.

I also started to experience some blood loss where my partner and baby left the room so staff could focus on me. I had a postpartum hemorrhage (PPH) on my uterus and lost 1.2L of blood. Essentially, once the placenta is delivered, the uterus should stop pumping blood to it and contract but for some reason it didn’t do this. Because I was a low risk pregnancy, there were no previous indications this could have happened. We read later that PPH has an incidence in Australia of between 5-15% and is one of the leading causes of maternal mortality.

Because there are numerous layers to the uterus, I was injected with drugs into four corners of my uterus to stop the bleeding as it was unknown where exactly the bleeding was coming from. This gave me a throbbing headache so I think I received some other drugs to counteract that which again made me vomit. If the drugs didn’t work things would have got more surgical and escalated quickly.

Once things had settled I was wheeled into the recovery room. Someone gave me water and I couldn’t believe how good it tasted. My partner entered the area and was shirtless having done skin to skin with baby. Baby was placed on my chest and I’m sad to say it’s the last thing I wanted but logic came in knowing it was so important for us to bond and physically connect. I got upset seeing the photo of baby on me with my head turned the other way. I was exhausted.

Following this, we were wheeled back to our hospital room and pain kicked in. My uterus needed to contract to its smaller size. Rather than periods of seconds/minutes or ‘waves’, I experienced a ‘tsunami’ of a long contraction with the most pain I’ve experienced in my life. I kept yelling “Omm” and then started profusely tapping my third eye trying to stimulate my parasympathetic nervous system. My partner was concerned asking me what I was doing. I knew I had to tell him so he wouldn’t worry. It was so hard to speak that I yelled “to deal with the fucking pain” - sorry babe. My partner reckons this lasted 1.5 hours. It took a while to get the anesthetist back to administer me with morphine and then for it to kick in.

By the time everything had settled and my partner was ready to get into the bed beside me (now that I have my own hospital bed in our room) he thinks it was about 4am.

A doctor had come to put a canula in my forearm since the nurses couldn’t do it since I was too pail. This is so I could receive some kind of rehydration liquids. I also had compression socks on which were plugged into a intermittent pneumatic compression (IPC) device to keep blood flowing and ensure I didn’t get a blood clot. Some nurses tried to freshen me up with wipe cleaning on my body since I’d sweat so much from the contractions.

After a couple of hours of sleep I could eat some breakfast and then shower. I couldn’t believe that I couldn’t sit up or get myself out of bed. I was put onto a wheely chair to go to the loo where I was bleeding and be showered by a nurse. The nurse encouraged me to stand to leave the shower but I then said “I feel fainty” and fainted. The emergency button was pressed so a team of nurses came in to get me back onto the bed.

Shortly after, blood test results showed that my hemoglobin had dropped 50% from 120 pre labour to 60 now which explained why I was so pale and fainted. Apparently the minimum is 80. My obstetrician said she rarely recommends blood transfusions but believes I needed two bags which we proceeded to do that night. Later in the week I also received an iron infusion.

Overall what happened was the opposite of our birth preferences/ plan. We knew previously that an induction would lead to a cascade of intervention which is why we tried to hold off as much as we could. The hospital policy is to be induced at 41w3d. I just can’t believe that what we knew would happen, did happen. In the moment when you’re in the hospital’s care, you think it must be there right thing to do... because they know what your preferences are, so why would the recommend or suggest a practice if it wasn’t necessary or there wasn’t a problem?

The need for my body to recover has impacted my ability and confidence to produce my own breast milk which was just a constant pressure during the hospital stay. There was an overwhelming amount of professionals and nurses always entering the room to check on something or give advice on something. We relied on them to provide us with donor breast milk or formula which wasn’t always timely and was surprised to see that the meals provided weren’t postpartum nourishing. Though we weren’t allowed family or friends to visit because of Covid-19 guidelines we only just managed one hour of spare time to FaceTime family and a few friends to share the news of baby’s arrival on the Monday. Wednesday was the first time

I left the hospital room to walk up and down the corridor. Though heavily supported in the hospital (we particularly appreciate a few nurses and the head nurse), we were so ready to be discharged at 10am Thursday 8 April to get home. It had been almost one week since I’d had fresh air and been outside.

The following day Friday 9 April we announced on social media the arrival of our baby.

[tinyshe]

The Fauci Files

At 79 years  old, Dr. Anthony Fauci — who has served as the director of the National  Institute of Allergy and Infectious Diseases (NIAID) since 1984 — has yet to  come out with the “Big One” — a vaccine or infectious disease treatment that  will allow him to retire with a victory under his belt.

He failed to  create a successful vaccine for AIDS, SARS, MERS and Ebola. A COVID-19 vaccine  is essentially his last chance to go out in a blaze of glory. As evidenced by  his history, he will stop at nothing to protect Moderna’s COVID-19 vaccine and  Gilead’s antiviral Remdesivir.

He even threw  tried and true pandemic protocols out the window when COVID-19 hit, turning  into an unquestioning spokesman for draconian liberty-stripping measures  instead. To echo a question asked by Dr. Sal Martingano in his article,1 “Dr. Fauci: ‘Expert’ or Co-Conspirator,” why are we not questioning this  so-called expert?

Fauci ‘Has Been Wrong About Everything’

The risk we  take when listening to Fauci is that, so far, he’s been wrong about most  things. In a July 14, 2020, “Opposing View” editorial in USA Today, White House  adviser Peter Navarro, director of the Office of Trade  and Manufacturing Policy, stated that  Fauci “has been wrong about everything that I have interacted with him on.”2 According to  Navarro, Fauci’s errors in judgment include:3

• Opposing  the ban on incoming flights from China in late January 2020.

• Telling  the American people the novel virus outbreak was nothing to worry about well  into February.

• Flip-flopping  on the use of masks — first mocking people for wearing them, and then insisting  they should. In fact, mid-July, he suddenly urged governments to “be as  forceful as possible” on mask rules.4

• Claiming  there was only anecdotal evidence supporting the use of hydroxychloroquine,  when the scientific grounds for it go as far back as 2005, when the study,5 “Chloroquine Is a Potent Inhibitor of SARS Coronavirus Infection and Spread,”  was published in the Virology Journal.

Fauci should have been well aware of this publication. According to that study,6 “Chloroquine has strong antiviral  effects on SARS-CoV infection of primate cells. These  inhibitory effects are observed when the cells are treated with the drug either  before or after exposure to the virus, suggesting both prophylactic and  therapeutic advantage,” the study authors  said. In other words, the drug worked both for prevention and treatment.

As noted by Navarro, more recent research found hydroxychloroquine reduced the  mortality rate among COVID-19 patients by 50% when used early.

Interestingly, in a March 24, 2020, interview7 with  Chris Stigall, Fauci did say that — were he to speak strictly as a doctor  treating patients — he would certainly  prescribe chloroquine to COVID-19 patients, particularly if there were no  other options.

Then, in August, he  flipped back to insisting hydroxychloroquine doesn’t work,8 even though by that time, there were several studies demonstrating its effectiveness  against COVID-19 specifically.

So, it appears Fauci has had a hard time making up his mind on this issue as  well, on the one hand dismissing the drug as either untested or ineffective  against COVID-19, and on the other admitting it would be wise to use, seeing  how the options are so limited.

Navarro continues:9

“Now Fauci says a falling mortality rate doesn’t matter when it is the single  most important statistic to help guide the pace of our economic reopening. The  lower the mortality rate, the faster and more we can open. So when you ask me whether I listen to Dr. Fauci’s advice,  my answer is: only with skepticism and caution.”

Fauci Has Done  Nothing to Help Unite the Country

While Fauci claims to be exasperated by how political the  pandemic has become,10 Robert F. Kennedy Jr. pointed out in an August 2, 2020, Instagram post11 that Fauci himself is, at least in part, part of the problem, as his double  standards on hydroxychloroquine have done much to polarize and divide the  nation:

“Fauci insists he will not  approve HCQ for COVID until its efficacy is proven in ‘randomized, double blind  placebo studies.’ To date, Dr. Fauci has never advocated such studies for any  of the 72 vaccine doses added to the mandatory childhood schedule since he took   over NIAID in 1984. Nor is he requiring them for the COVID vaccines currently  racing for approval.

Why should chloroquine be  the only remedy required to cross this high hurdle? HCQ is less in need of  randomized placebo studies than any of these vaccines since its safety is well  established after 60 years of use and decades on WHO’s listed of ‘essential  medicines.’

Fauci’s peculiar hostility  towards HCQ is consistent with his half century bias favoring vaccines and  patent medicines. Dr. Fauci’s double standards create confusion, mistrust and  polarization.”

In a June 10, 2020, article,12 Global  Research also questioned Fauci’s many attempts to disparage the drug for no  apparently valid reason; even promoting the fake (and ultimately retracted) Lancet  study that claimed to show hydroxychloroquine was dangerous.  At the end of the day, who benefits? Well, certainly it benefits the drug and  vaccine industries, which seems to be where Fauci’s loyalties lie.  

Fauci’s Bias Is Hard to Miss

While Fauci is  not named on the patents of either Moderna’s vaccine or Remdesivir, the NIH  does have a 50% stake in Moderna’s vaccine,13 and the recognition that would come with a successful vaccine launch would  certainly include Fauci.

He also has  lots to lose — if nothing else, his pride — if Remdesivir doesn’t become a  blockbuster, as his NIAID is sponsoring the clinical trials.14 The NIAID also supported the original research into Remdesivir, when it was  aimed at treating Ebola.15

His bias here  is clear for anyone to see. April 29, 2020, he stated16 Remdesivir "has a clear-cut and  significant positive effect in diminishing the time to recovery." How good  is that? Patients on the drug recovered in 11 days, on average, compared to 15  days among those receiving a placebo. Overall, the improvement rate for the  drug was 31%.

Meanwhile, research17 now shows hydroxychloroquine reduced mortality by 50% when given early, and  many doctors anecdotally claim survival rates close to 100%. This still isn’t  good enough for Fauci, who continues insisting hydroxychloroquine is a bust.18

His stance on these two drugs certainly  doesn’t make sense based on the data alone. But it does make sense if he wants  (or has been instructed) to protect the profits of Remdesivir.

As director of NIAID, which has  been part of Remdesivir’s development from the start, why wouldn’t he want to  see it become a moneymaker for the agency he dedicated his career to? It also  makes sense when you consider his primary job is to raise funds for biodefense research,  primarily vaccines but also diagnostics and drug therapies.19,20

Fauci Doubts Safety of Russian Vaccine

Early in August  2020, Russia announced they would begin vaccinating citizens with its own  COVID-19 vaccine, despite not finishing large-scale human trials.21 The announcement drew skepticism from American infectious disease specialists,  including Fauci, who said he has “serious doubts” that Russia’s COVID-19  vaccine is actually safe and effective.22

Fauci  conveniently ignores the many failed attempts to create other coronavirus  vaccines over the past two decades, including vaccines against SARS and MERS.

He’s probably  right on that point. It’s hard to imagine you can prove safety and  effectiveness in a mere two months of trials. But the fast-tracked vaccine efforts of the U.S. and EU are hardly bound to  be significantly better, considering the many shortcuts that are being taken.

Fauci Ignores Two Decades of Failed Coronavirus Vaccines

Despite being in a position to know better, Fauci  conveniently ignores the many failed attempts to create other coronavirus  vaccines over the past two decades, including vaccines against SARS and MERS. A   paper23 by Eriko Padron-Regalado, “Vaccines for SARS-CoV-2: Lessons From Other Coronavirus Strains” reviews some of these past experiences. As noted in the  Conservative Review:24

“Since  their emergence in 2003 and 2012 respectively, no safe and efficacious human  vaccines for either SARS-Cov1 or MERS have been developed.

Moreover,  experimental non-human (animal model) evaluations of four SARS-Cov1 candidate  vaccine types, revealed that despite conferring some protection against  infection with SARS-Cov1, each also caused serious lung injury,  caused by an overreaction of the immune system, upon viral challenge.25

Identical  ‘hypersensitive-type’ lung injury occurred26 when mice were administered a  candidate MERS-Cov vaccine, then challenged with infectious virus, negating the  ostensible benefit achieved by their development of promising … ‘antibodies’ …  which might have provided immunity to MERS-Cov.

These  disappointing experimental observations must serve as a cautionary tale for  SARS-Cov2 vaccination programs to control epidemic COVID-19 disease.”

NIAID Safety Controversies and Ethics Violations

When recently asked  for a rebuttal to criticism of his leadership during the pandemic, Fauci replied,  “I think you can trust me,” citing his long record of service in government  medicine. However, that long service record is fraught with ethics and safety  lapses.

For example, in  2005, NPR reported27 the NIH tested novel AIDS drugs on hundreds of HIV-positive children in state  foster care during the late 1980s and90s without assigning patient advocates to  monitor the children’s health, as is required by law in most states.

Fauci was appointed director of the NIAID in 1984. The  AIDS research was part of his research portfolio, and the AIDS research  division reported directly to him, so these violations occurred on his watch.28 In  2008, two NIH biomedical  ethicists published a paper on the controversial practice of using wards of the  state as guinea pigs, noting:29

"Enrolling wards of the  state in research raises two major concerns: the possibility that an unfair  share of the burdens of research might fall on wards, and the need to ensure  interests of individual wards are accounted for ... Having special protections  only for some categories is misguided. Furthermore, some of the existing   protections ought to be strengthened."

Under Fauci, the NIAID became the largest funder of  HIV/AIDS in the world.30 Despite  that, numerous articles over the years have discussed how AIDS activists have  been less than satisfied with Fauci and the NIAID.31,32,33 A  1986 article stated:34

“If  Fauci were less intent on amassing power within the federal health bureaucracy  … he would have left AIDS treatment research with the NCI, where it began,  relying on that institute's proven expertise in organizing large, multisite  clinical trials for cancer therapies."

A July 23, 2020, article in Just the News lists several  other safety and ethics problems that Fauci has been involved in through the  years, including conflict of interest violations in vaccine research.35

Just the News also interviewed NIAID chief of ethics and  regulatory compliance Dr. Jonathan Fishbein, whom the NIAID was  forced to reinstate in 2005 after it was determined that Fishbein had been   wrongly fired in retaliation for raising concerns about lack of safety in some  of the agency’s research:36

“Fishbein said … Fauci failed to take responsibility for the   managers and researchers working below him when signs of trouble emerged,  allowing problems to persist until others intervened. ‘Fauci is all about  Fauci,’ Fishbein said. ‘He loves being the headline. It’s his ego.’”

Fauci’s Connections  to Wuhan Lab

By now, you  probably also know that the NIAID funded gain-of-function research on  coronaviruses at the Wuhan Institute of Virology. As reported by Newsweek:37

“In 2019, with the backing of NIAID, the National  Institutes of Health committed $3.7 million over six years for research that  included some gain-of-function work. The program followed another $3.7 million, 5-year project for collecting and studying bat coronaviruses, which ended in  2019, bringing the total to $7.4 million.”

This money was  not given directly, but rather funneled to the Wuhan lab via the EcoHealth  Alliance. According to a recent report by The Wall Street Journal,38 the NIH is now insisting EcoHealth Alliance submit all information and materials from the Wuhan lab before it’s allowed to resume funding.

Fauci is a  longtime proponent of dangerous gain-of-function research. In 2003, he wrote an  article39 published in the journal Nature on how “the world needs new and creative ways  to counter bioterrorism.”

“We will  pursue innovative approaches for modulating innate immunity to induce and  enhance protection against many biological pathogens, as well as simple and  rapid molecularly based diagnostics to detect, characterize and quantify  infectious threats,” Fauci wrote.

“These are lofty goals  that may take many years to accomplish — but we must aspire to them. Third, we  must enormously strengthen our interactions with the private sector, including  biotechnology companies and large pharmaceutical corporations.

Many biodefence-related  products that we are pursuing do not provide sufficient incentives for industry  — the potential profit margin for companies is tenuous, and there is no  guarantee that products would be used.

Therefore, we will seek non-traditional  collaborations with industry, for example guaranteeing that products will be  purchased if companies sign up … so that we can quickly make available  effective vaccines and treatments …”

With that, there can be little question about which team  Fauci is on. He’s on the side of drug and vaccine makers, and has been for   decades. There’s no money to be made by either the agency or its private  collaborators from natural products such as vitamin D, vitamin C, quercetin or  its drug equivalent, hydroxychloroquine. All of these are dirt-cheap and off  patent.

Prediction Track Record = Null

Fauci’s  predictions for COVID-19 mortality have also turned out to be as inaccurate as  all of his previous predictions. In 1987, he predicted heterosexual infection  of HIV/AIDS would rise to 10% by 1991. It never rose above 4%.

He predicted  the bird flu would result in 2 million to 7 million deaths. In the end, the  avian H5N1 flu killed 440 worldwide. He sought billions of dollars to combat  the threat of Zika, a virus that fizzled without making much of an impact anywhere.40

When you look  at his track record, you realize he’s predicted “nightmare” scenarios for  decades, none of which have materialized.   Last but not least, Dr. Fauci serves on Bill Gates leadership council.

[a-piece-of-peace]

Is your community prepared?: Community Involvement in Disaster Risk Reduction and Management

As someone living in one of the communities that make up one of the vast metropolises that continue to thrive economically, Quezon City deems urban resilience a vital aspect and social and economic concern in strengthening the city’s resilience. Where families and households are strong enough to withstand calamities and are also able to restore economic activity amidst the myriad of disasters. 

To better visualize the overall purpose of this blog post, I would like to first share the economic and environmental issues the Philippines is currently facing.

Due to the geographic and physical features and location of the country, it is considered to be one most disaster-prone countries in the world. Situated along the western segment of the Pacific Ring of Fire, it lies in one of the most active part of the Earth characterized by an ocean encircling belt of active volcanoes and earthquake generators. Together with twenty-two (22) active volcanoes and six (6) known fault lines, the Philippines also sits astride the typhoon belt. The major part of the country experiences annual torrential rains and thunderstorms from July to October, with about nineteen (19) typhoons entering the country’s area of responsibility in a year with eight (8) to nine (9) of them making landfall on the country’s soil. This does not only make the Philippines vulnerable to flooding, but also vulnerable to climate change.

Sea level rise is one of the best-known climate change’s many dangers. As humanity pollutes the atmosphere with toxic substances that destroys the atmosphere, the planet becomes warmer and warmer. Thus, ice sheets and glaciers melt and warming sea water expands and increases in volume of the world’s oceans. The pollution and continuous onslaught of environmentally-detrimental human activities has become one of the top contributors to this growing concern. Especially in urban areas like Metro Manila, one of the most obvious human activity that sets the ground for environmental degradation is poor waste management. Improper wastes disposal, inefficient waste collection, lack of disposal facilities and the sheer loss of basic human decency and discipline has resulted in becoming one of the greatest threats to country’s environment and public health.

After hearing all these things, what can we do? Well, as of course in true Filipino fashion. We overcome. In our classes in Disaster Risk Reduction Management (DRRM), the term “Resilient”, Filipino or English, is a source of contention and controversy. While resilience is a noble word, it is also subject to scrutiny as to what does it mean to the country’s ability to bring back the sense of normalcy and improving itself. It shouldn’t simply mean smiling whilst standing knee-deep in floods or accepting the fact that our country’s legal justice system will always be something out of a dystopian novel, or even going far back as to think, “well, if it’s not broken, don’t fix it” to the state of our transportation system. UNISDR (United Nations Office for Disaster Risk Reduction) defines resilience as “the use of recovery, rehabilitation, and reconstruction phases after a disaster to increase ‘resilience’ of nations and communities through integrating DRR measures into the restoration of physical infra and societal systems, and into revitalization of livelihoods, economies, and the environment.” In other words, we learn from the events for us to be “more resilient.” For us to improve. And how can we do that? We start in our most basic unit of society, the family, then to the community.

To take a closer look to the one the communities preparing for such disasters, I went to visit my local barangay, Barangay Bagumbuhay.

Barangay Bagumbuhay’s hall is right along the residential area of Miguel Malvar Street.  Easily accessible by the Light Railway Transit (LRT) System (though it is currently closed for operations) or by jeeps coming from Cubao or Katipunan, going through Aurora boulevard.

Due to the location of the barangay, not a lot of natural hazards were identified. According to PHILVOC’s faultfinder, the barangay is approximately 1.6 km. from the nearest active fault trace, which is the West Valley Fault.  

The barangay also had an advantage of being located right on top of a hill-like landmass, giving it the ability to rule out severe cases of flooding. However, there were still hazards to the community that were present. Namely, Anthropogenic hazards which were the structures and residential areas that were violating building code. Particularly the residential areas that were built atop the creek along F. Castillo Street. The officials fear that if these structures weren’t fixed immediately, they may become a danger to the residents should an offshoot of a disaster happened (e.g. fires). Blocked roads and alleys were also a danger since they served as a blockage to the entry and exit of residents to and from their homes, making it difficult for them to move through. 

The officer in charge of the Disaster Risk Reduction and Management office of  barangay Bagumbuhay, Estiño Martinez, introduced me to the various DRRM plans they had prepared in case the community faced a disaster. There were plans of evacuation locations for the nearby residents as well of those people who need special care and attention. Sr. Martinez provided a list of projects that had already been done and to be done (for 2020) in order to fulfill their duty of reducing the risk of any hazards that pose a threat to the community.

Sr. Martinez accompanied us in viewing the various preparations the had in store. For medical emergencies, for fire accidents, as well as for the aftermath of any disaster.

The multipurpose court to be used as an evacuation center for the community.

A funeral parlor and holding area for the families who are cannot afford the expenses of having a proper burial for their family member.

A Barangay Disaster Risk Reduction and Management Center right behind the hall. This includes the various materials and equipment to be used if in case of an emergency.

The fully-equipped ambulance and fire truck on stand-by 24-7. Sir. Martinez also informed us that the people manning these vehicles were always on site. He told us that they had shiftings in place for these positions as to prevent lacking important personnel if and when needed. 

The barangay council also set forth a clearing operation for the entire Miguel Malvar Street. This was to prevent blockage or traffic for the emergency vehicles going in and out of the barangay hall area. 

When I asked about the issues that the barangay faced in implementing their plans, he told us how sometimes there were residents who refused to take part in an operation they called Ugnayan. This system allowed residents to be informed of the basic and immediate reparations should a disaster ever happen. Seminars and workshops going on in the barangay is also openly given and provided to the residents. Sr. Martinez explained to us how participation of all the individual members of the community is what will ultimately help the community, not just the barangay personnel. The interview was then abruptly cut due to the schedules Sir. Martinez had. 

Though our time was short, he was able to answer all my questions and expound on his answers in a concise manner. I am extremely grateful to Sir Martinez for giving me his time in answering all my questions.

The interview led me to many conclusions about how vital it is for a community to be prepared for such disasters. In case of any disaster or emergency, before any government relief & support reaches or outside help is utilized, it is the Community which has to respond immediately (at the hour). As the Community plays the role of First Responder, it is critical that there is adequate awareness and preparedness at the Community level especially among the most vulnerable set of communities residing in the most vulnerable areas. 

Disaster preparedness provides a platform to organize effective, realistic and coordinated planning, reduces the waste of efforts and increase the overall effectiveness of the individual, household and community members disaster preparedness and response efforts. Disaster preparedness activities that are planned with risk reduction measures can prevent disaster situations and also result in saving maximum lives and livelihoods during any disaster situation, enabling the affected community to easily get back on its feet within a short period of time. Community preparedness can be thought of as the advance capacity of a community to respond to the consequences of an adverse event by having plans in place so that people know what to do and where to go if a warning is issued or a hazard is observed.

What we plan with our families, our community, and in our country helps us consider our emergency response activities in light of existing and new disaster risks that is affecting us and our country. This allows us to design or adjust our activities so that people and communities and in the end, our country to become safer and more disaster-resilient, as well as safeguarding efforts to create and expand enabling conditions for sustainable poverty alleviation and development. This can help strengthen our communities and reduce our vulnerability to the multiple natural disasters heading our way. 

The best way we can do to help our community and our country is to raise awareness. People being informed and equipped with the right knowledge will go a very long way. Just as the saying goes, it is better to know it and not need it than to need it and not know it. 

We as a community must urge our those we have elected to government positions to quickly move in planning and developing projects that will protect the public. We must build resilience in ourselves and also in the systems of our society. We must approach climate change with fear, for what our children’s future will be, and courage and hope, that we can heal what has been done.

To our public officials, they must create and support national policies and strategies allocating the resources of the country to manage the risk threatening it. Everyone must help in pushing for change and improvement in access to quality primary health care even before disaster strikes. 

To our workforce, we must be trained and equipped in planning for all types of emergencies. We need to be able to identify hazards, vulnerabilities, and our own capacities to lessen risks.

To the public, we as collective need to promote risk awareness of emergencies as well as providing health education to the youth. There is so much we can do when we join together for a cause that will protect us and our families. 

True “resilience”, I believe, is not tolerance or ignorance of the system that is broken in the front of adversity. It is the triumphant improvement of ourselves, physically and socially to become better. A better Filipino nation that faces calamities not in a defeatist manner but with a strength of Filipinos coming together.

[your-dietician]

India Supercharged Its Economy 30 Years Ago. Covid Unraveled It in Months

New Post has been published on https://tattlepress.com/economy/india-supercharged-its-economy-30-years-ago-covid-unraveled-it-in-months/

India Supercharged Its Economy 30 Years Ago. Covid Unraveled It in Months

(Bloomberg) — Thirty years ago, on a summer evening in late July, India liberalized its Soviet-style economy in a transformation that eventually pulled about 300 million out of poverty, fueling one of the biggest wealth creations in history.

Then came the world’s fastest coronavirus surge which left overflowing hospitals turning away the dying and crematorium smoke darkening city skies.

Years, and perhaps decades, of progress have been unwound in months, as many Indians who had clawed their way out of poverty face grim job prospects and carry heavy debt loads wracked up to get themselves and loved ones through the pandemic. The devastation has highlighted just how much poor health care and infrastructure — often neglected in the boom after liberalization — are holding back the nation and its people.

More than 200 million have gone back to earning less than minimum wage, or $5, a day, the Bangalore-based Azim Premji University calculates. The middle class, the engine of the consumer economy, shrank by 32 million in 2020, according to the Pew Research Institute. That means India will be regressing on vital fronts just as its global importance is growing.

This decade, India is expected to become the world’s most populated nation, taking that mantle from China, which for years drove global growth. But the Indian economy is grappling with big threats even as it becomes home to the kind of young, working-age population that drove lengthy booms in other nations.

“We’re talking about a decade of lost opportunities and setback,” said Arvind Subramanian, a fellow at Brown University and a former chief economic advisor to Prime Minister Narendra Modi’s administration. “Unless there are some big reforms and fundamental changes in the way economic policy is done, you’re not going to be anywhere close to what we saw in the boom years. A lot needs to happen in order to get back to the 7%, 8% growth that we desperately need.”

Even before the pandemic, cracks had begun to emerge. Modi came to power in 2014 amid voter frustration over scandals and policy paralysis that had contributed to bad loans at banks and threatened to derail Indian growth. Yet, the economy has faced other hurdles in recent years including Modi’s 2016 cash ban, which roiled the informal sector, and a hurriedly implemented new tax system.

Story continues

Modi had pledged to turn India into a $5 trillion economy by 2025, but the pandemic is set to push that back by years. The International Monetary Fund expects India to grow 6.9% in the next fiscal year that starts in April 2022, lower than the more than 8% needed long term to reach Modi’s ambitious target and create jobs for the millions entering the work force.

Jim O’Neill, chairman of Chatham House in London — who coined the term BRICs to describe the emerging markets of Brazil, Russia, India and China while serving as a top Goldman Sachs Group Inc. economist — is these days cautious on India, largely because the government hasn’t made many of the long-term structural changes he believes are needed for it to reach its full potential.

When still at Goldman Sachs, O’Neill says he presented a paper to Modi in 2013, before he became prime minister, recommending 10 things that would allow the Indian economy to be 40 times larger by 2050. The list included making substantial improvements to areas like infrastructure, education, introducing better public-private partnerships in areas like healthcare, further liberalizing financial markets and working on environmental issues. Modi hasn’t fully pursued these ideas, O’Neill said.

“India’s got these fantastic demographics, which should have given it the potential to be rising a lot more strongly, possibly at the same kind of double digit rates China enjoyed for a long time,” O’Neill said. Yet “the Indian system seems to quite often smother itself, as we’ve seen sadly a few times during the Covid pandemic,” he said.

A government spokesperson didn’t respond to request for comment, but the Modi administration has in recent weeks acknowledged the need for longer term changes. “If we are looking at getting growth — of 8%-10% — back on a sustainable path, we have to think about not just a current revival,” Sanjeev Sanyal, the government’s principal economic adviser, said at the India Global Forum on June 30. Structural changes are needed and to that end the government is constantly opening up new sectors of the economy, he said.

Once the fastest-growing major economy, India saw its biggest ever contraction last year — shrinking more than 7% — after a stringent nationwide lockdown. Just when the economy started showing some momentum, another wave of infections hit the nation. This year, the central bank expects India to grow at 9.5%, sharply lower than the double-digit rebound many had earlier expected. That estimate is heavily boosted by the comparison with the sharp contraction of the previous year, and many economists expect it could be pared even further.

Foreign direct investment surged 19% last year, but even that remains lower as a percentage of GDP compared with countries like Singapore and Vietnam. And a big portion of the foreign investment went to billionaire Mukesh Ambani’s digital platforms.

Some experts, including former central bank head Duvvuri Subbarao, have warned of a K-shaped recovery for India, where the rich get richer and poor get poorer. “Growing inequalities are not just a moral issue,” said Subbarao. “They can erode consumption and hurt our long-term growth prospects.”

The of the two richest men in Asia – Ambani and ports magnate Gautam Adani — are Indians, and their net worth has surged as stocks rallied on the back of cheap liquidity worldwide and tax cuts for companies even as economic growth slumped. Meanwhile, overall Indian wealth — or the value of financial and real assets owned by households minus debts — fell by $594 billion, or 4.4%, in 2020, according to Credit Suisse Group AG.

Thirty years ago, India was forced to remake its economy. A mammoth trade deficit and plunging foreign exchange reserves necessitated a loan from the International Monetary Fund. On July 24, 1991, then finance minister, Manmohan Singh, announced major steps to cut tariffs and encourage trade, essentially opening up the economy to the outside world.

In the boom that followed liberalization, growth crossed 8%. Technology giants like Infosys were born and start-ups worth billions are now mushrooming in Bangalore. A new middle class emerged that watched Netflix and shopped online on Amazon. In the south, the Wistron factory won special economic benefits to assemble Apple iPhones. India became the world’s biggest supplier of generic medicines and the Serum Institute of India became the world’s biggest vaccine maker. An Indian exchange now handles the world’s highest number of derivatives contracts.

Yet there were signs that India wasn’t hitting its full potential. Average GDP growth of 6.2% over 30 years has been lower than China’s 9.2% and even lagged Vietnam’s 6.7%. For years, Indians have been living shorter lives and are now earning less on average than people in smaller nations like Bangladesh.

Vast inequities developed. Researchers have found wealthier people in urban areas and from upper castes were taller in India, a sign of development favoring groups that were already advantaged. The percentage of women joining the workforce fell from 30.3% in 1991 to about 21% in 2019, according to data from the International Labor Organization. India’s government spent less than 2% of GDP on healthcare before the pandemic.

“Had the healthcare system not been so neglected for so long, India would have been prepared to face the Covid-19 crisis,” said Jean Dreze, the Belgian-born Indian economist and a lecturer at Delhi University. “Had India built a more robust social security system, the humanitarian toll of the crisis would not have been so catastrophic.”

Unlike the old guard in 1991, Modi has turned the economy more inward, focusing on self-reliance and homegrown companies. Despite championing free trade in global forums, he’s raised tariffs on goods including electronics and medical equipment, partly reflecting global trends.

Some of those decisions came back to haunt India when citizens struggled to import life-saving products like oxygen concentrators during the pandemic. Top scientists wrote to Modi, asking him to reverse protectionist duties imposed on key items needed to study the coronavirus and its variants including the delta one, which now threatens the globe.

After pledging to contribute to global vaccine programs, the Modi government slowed exports of Covid-19 shots, derailing the inoculation program of a World Health Organization-backed initiative.

“India’s ambition of being seen as a major player on the world stage has taken a substantial hit as the pandemic has laid bare the weaknesses in the capacity and competence of its government,” said Eswar Prasad, professor of trade policy at Cornell University.

The key question for global investors now is whether India will get old before Indians get rich. Netflix is counting on India for its next 100 million customers. Bezos is pouring billions of dollars — and even braving Indian courts — to battle India’s richest man Ambani for a slice of the only open retail market with more than a billion people.“The pandemic has set us back hugely, and we were already on a growth downswing when it happened,” said Indira Rajaraman, an economist and a former member of the Reserve Bank of India’s board. “Going forward it all depends on how cleverly we design the way we come out of these doldrums.”

More stories like this are available on bloomberg.com

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[ourhaileydavies]

Juniper Publishers-Open Access Journal of Head Neck & Spine Surgery

Chiari Malformation Type III with Good Outcome: Case-Report and Review of Clinical and Radiological Findings

Authored by Hosein Safari

Abstract

Chiari III malformation, one of the rare variants of Chiari malformations, is including a small dysplastic posterior fossa, hydrocephalus, medullary abnormalities, and hindbrain herniation into a low occipital/high cervical encephalocele. This type can be lethal if not treated and is related to severe neurological deficits, so surgical care should immediately be undertaken. We are presenting a 1.5-month-old male infant with Chiari III malformation that was managed surgically with good outcome in addition, review the radiological, clinical and pathogenesis of Chiari III malformation.

Introduction

Type III Chiari malformation is a very rare condition that is described by Chiari in 1891.This type of Chiari defined as hindbrain herniation into a high cervical encephalocele or low occipital, and osseous defects with features of type II Chiari malformation (including a small posterior fossa, herniated dysplastic posterior fossa content, hydrocephalus, medullary kinking, and tectal beaking) [1-5]. In literature, approximately 60 cases have been reported since 1891 to have Chiari III (Table 1).

Chiari III malformation is related to early mortality, if not being treated. Since it has a poor outcome, it is related to severe neurological deficits, developmental delays, and seizure in long term, if being survived [6]. We are presenting a 1.5-month-old case of Chiari type III that was managed surgically with good outcome. In addition, review the pathogenesis, radiological, and clinical features of Chiari III malformation.

Case

A 1.5-month-old male infant presented to hospital emergency department with complaint of large congenital occipital mass. He was born at full-term, as the product of normal delivery, second child of a low socioeconomic non-consanguineous parents. There was no history of medication or maternal infection. The mother had no history of use of iron products, too. On examination, the child had 3350gr weight (wt.), 32 cm head circumference (H.C.) at birth, and 4000gr wt., 36cm H.C. at the day of admission. He had no neurological deformity or cranial nerve palsy, and had normal eye movement with no nystagmus. Spontaneous movements of all extremities were present. All reflexes were normal. Chest was clear, with normal breathing sound. There was a soft, 6*5cm trans-illuminate mass in occipital and upper cervical region, which was tense on crying and was covered with thin skin (Figure 1). There was no cerebrospinal fluid (CSF) leakage. There was no history of fever or discharge from the mass. The biochemical and hematological parameters were normal.

Magnetic Resonance Imaging (MRI) was performed on a 1.5T MR scanner and revealed a bony defect (approximately 2*2cm) in the occipital and upper cervical (C1-C2 vertebrae) region that had an encephalocele with partial herniation of the cerebellum and a part of the brainstem. There was no hydrocephalus (Figure 2-5). No tethering or syringomyelia was revealed in screening MRI of the lumbar spine.

After general anesthesia, the patient was turned prone. The skin over the mass was incised in midline and was dissected around the mass. Below the skin, the covering dura was seen. Suboccipital craniotomy was done. On opening the dura, herniated cerebellum was seen in the sac (Figure 6). Cord and brain steam was untethered and cranio-cervical junction adhesions were released. There was no need for ventrico- peritoneal shunt. Secondary closure of the dura was done with the pericranial patch. The child was extubated in the recovery room. Early post operation and on the fifth day brain computed tomography (CT) scan was done that didn't show hydrocephalus. Examination of lower cranial nerve was normal. Postoperative imaging revealed well positioned brain steam and cerebellum (Figure 7). Patient was discharged a week after surgery. Till now, 1 year after surgery, patient has good outcome with normal developmental and neurological examination.

Discussion

Hans Chiari, described and characterized hindbrain deformities as the Chiari malformation in 1891 [5]. One of the rare variants is Chiari malformation type III, that is characterized by osseous defects and occipital or high cervical encephalocele and some anatomical characteristics of Chiari malformation type II, including a small posterior fossa, herniated dysplastic posterior fossa content, hydrocephalus, medullary kinking, and tectal beaking [1-4]. Chiari malformation type III has poorer outcomes that type I and II, and those who survive develop with developmental delays and severe neurological deficit [6].

Till now, the pathogenesis of Chiari malformation type III remains unclear, but Chiari believed this variant was due to hydrocephalus [5]. Some have suggested that primary abnormal mesodermal defect is related to this type [7]. Some authors have stated that during intrauterine period, escape of CSF from an open neural tube defect has caused destination of primitive ventricles and small skull, like what happens in Chiari II malformation [8]. Others believe that caudal displacement of hindbrain and hypoplastic posterior fossa are the result of lack of distension of the embryonic ventricular system secondary to abnormal neurulation [4]. Others have posited that failure of ossification centers to fuse completely or failure of induction of endochondral bone by incomplete closure of the neural tube are responsible for bony defects and encephalocele [4,9]. Finally, some believe that mesenchymal development disturbance in embryological life is the secondary event in Chiari III malformation and the underlying problem is likely to be the deranged CSF dynamics [10].

Chiari III malformation incidence is 0.65-4.4% among all of the Chiari malformations [11-13] and have been diagnosed prenatally to 14-years-old [4]. The most common to the least position of encephalocele are low occipital/high cervical [14,15]. Symptoms are strongly related to the amount of herniated brain structures, ranges from asymptomatic in those with only bulging in the back of the head [16] to clinical findings like downbeat nystagmus and titubation, ataxia, sensory loss, respiratory failure, hyperreflexia, spastic muscle or hypotonia, and inspiratory stridor [17,18].

Occipital bone defects are seen in some, but not all Chiari III malformations [19], and 70% of cases have been reported to have incomplete fusion of the posterior arches of C1 [4]. Contents of encephalocele in Chiari malformation III is usually nonfunctional and contains necrosis of neural tissue, gliosis, fibrosis, meningeal inflammation, cerebral or cerebellar tissue, ventricles, and reactive astrocytes [6,15]. Cerebellum, occipital lobe, and parietal lobe are the most to the least common parts of brain occurring in the sac. Ectopic venous sinuses and aberrant deep veins are common [15]. Other anomalies of the brain are including posterior falx cerebri aplasia, lack of cerebellum, posterior petrous pyramids and the clivus scalloping, syringomyelia, and creeping of the cerebellar hemispheres around the brain stem [4,15]. Though hydrocephalus is not an essential finding, has been reported in 88% of the cases [6]. Syringomyelia is commonly present [16,18].

Ultrasound has been used antenatally, the earliest report is at 18 weeks of gestational age (WGA) [20], to identify cranial anomalies [3,21]. Elective C section is the standard plan of delivery when encephalocele diagnosed [20]. MRI is the modality of choice and can identify the amount of brain occurring in the encephalocele [6,15], and is used prenatally after abnormalities were seen on fetal ultrasound [20]. Though occipital/cervical encephalocele is not necessarily associated with a poor prognosis, Chiari III malformation can be lethal if untreated, so surgical care should be undertaken.

Time of surgery remains controversial, some believe that immediate closure of the defect is the ideal treatment while others believe if the sac is covered with normal skin, it is rarely needed to perform surgery urgently [6,16], but primary closure remains the treatment of choice [6,15]. Preserving neurological function while as much as possible neural tissue in the encephalocele is resected, reconstruction and repair of dura, and preventing future tethering are the goals of surgery [6,15]. Some authors report placing a temporary external drain [1], or a shunt before encephalocele closure [22-24]. Overall mortality rate is 29% [7,25], and postoperative mortality accounts for 22% of all mortalities [15]. Neurological function outcomes depend on the neurological status before surgery [24]. Positive prognostic factor is less than 5cm of herniated brainstem [6], and hydrocephalus, neural tissues in the sac, large size of sac, and intermittent respiratory stridor are the negative prognostic factors [7,18].

For more articles in Open access Journal of Head Neck & Spine Surgery | Juniper Publishers please click on: https://juniperpublishers.com/jhnss/index.php

[covid19updater]

COVID19 UPDATES 04/17/2020

MORNING:

UK: Wearing face masks while travelling in London should be compulsory, city mayor Sadiq Khan has told the government. LINK

UK: Hopes that Britain can achieve widespread Covid-19 immunity by the end of the lockdown have been dealt a devastating blow after research suggested only a small proportion may have acquired resistance to the disease. LINK

Germany: German Zoo May Feed Animals to Animals as Funds Dry Up in Pandemic LINK

Texas: Area doctor sees success in experimental COVID-19 treatment using Melatonin LINK

US: April 24th: Amazon employees plan ‘online walkout’ to protest firings and treatment of warehouse workers LINK

China: BREAKING: Wuhan, where the coronavirus pandemic began, revises death toll to 3,869, an increase of 50%

UK: We have discovered evidence that at least one NHS trust is gently discouraging doctors from giving Covid-19 as a cause of death. LINK

Massachusetts: “The Mayor and the Executive Health Officer hereby order all residents of and visitors to the City of Brockton to stay at home between the hours of 9:00 p.m. and 6:00 a.m. unless they are actively providing or receiving COVID-19 Essential Services. Anyone in violation of the executive order may be fined up to $1,000.” LINK

Spain: Number of cases in Spain increases by 2.8%. From yesterday to today, 5,252 new cases of Covid-19 in Spain have been confirmed, it was announced. The value corresponds to an increase of 2.8%. Regarding the number of fatalities, this has also increased slightly from yesterday to today, with 585 confirmed deaths by Covid-19. Yesterday was 551.

France: 'I wasn't elected for that!' French mayor forced to run NAKED from his house after attack by angry local during lockdown A French mayor fled for his life during the nationwide coronavirus lockdown after a disgruntled citizen forced him to strip naked at gunpoint in his own home. LINK

South Korea: Coronavirus relapse cases continue to rise in South Korea -- after full recoveries, 163 more tested positive again.

US: Lindsey Graham calling for sanctions on China for being the "largest state sponsor of pandemics on the globe" (’Murica!)

UK: UK reports 847 more virus deaths. The UK has reported 847 more virus deaths in hospitals, taking the total to 14,576.

China: Professor Luc Montagnier, 2008 Nobel Prize winner for Medicine, claims that SARS-CoV-2 is a manipulated virus that was accidentally released from a laboratory in Wuhan, China. LINK

World: Why did the W.H.O. Ignore an email from Taiwanese health officials in late December alerting them to the possibility that CoronaVirus could be transmitted between humans? Why did the W.H.O. make several claims about the CoronaVirus that ere either inaccurate or misleading...........in January and February, as the Virus spread globally? Why did the W.H.O. wait as long as it did to take decisive action? Lanhee Chen, Hoover Institution Fellow @foxnews​

COVID19 HUMOR:

Covid-19 : The Rules 1. Basically, you can't leave the house for any reason, but if you have to, then you can. 2. Masks are useless, but maybe you have to wear one, it can save you, it is useless, but maybe it is mandatory as well. 3. Stores are closed, except those that are open. 4. You should not go to hospitals unless you have to go there. Same applies to doctors, you should only go there in case of emergency, provided you are not too sick. 5. This virus is deadly but still not too scary, except that sometimes it actually leads to a global disaster. 6. Gloves won't help, but they can still help. 7. Everyone needs to stay HOME, but it's important to GO OUT. 8. There is no shortage of groceries in the supermarket, but there are many things missing when you go there in the evening, but not in the morning. Sometimes. 9. The virus has no effect on children except those it affects. 10. Animals are not affected, but there is still a cat that tested positive in Belgium in February when no one had been tested, plus a few tigers here and there… 11. You will have many symptoms when you are sick, but you can also get sick without symptoms, have symptoms without being sick, or be contagious without having symptoms. Oh, good grief! 12. In order not to get sick, you have to eat well and exercise, but eat whatever you have on hand and it's better not to go out, well, but no… 13. It's better to get some fresh air, but you get looked at very wrong when you get some fresh air, and most importantly, you don't go to parks or walk. But don’t sit down, except that you can do that now if you are old, but not for too long or if you are pregnant (but not too old). 14. You can't go to retirement homes, but you have to take care of the elderly and bring food and medication. 15. If you are sick, you can't go out, but you can go to the pharmacy. 16. You can get restaurant food delivered to the house, which may have been prepared by people who didn't wear masks or gloves. But you have to have your groceries decontaminated outside for 3 hours. Pizza too? 17. Every disturbing article or disturbing interview starts with " I don't want to trigger panic, but…" 18. You can't see your older mother or grandmother, but you can take a taxi and meet an older taxi driver. 19. You can walk around with a friend but not with your family if they don't live under the same roof. 20. You are safe if you maintain the appropriate social distance, but you can’t go out with friends or strangers at the safe social distance. 21. The virus remains active on different surfaces for two hours, no, four, no, six, no, we didn't say hours, maybe days? But it takes a damp environment. Oh no, not necessarily. 22. The virus stays in the air - well no, or yes, maybe, especially in a closed room, in one hour a sick person can infect ten, so if it falls, all our children were already infected at school before it was closed. But remember, if you stay at the recommended social distance, however in certain circumstances you should maintain a greater distance, which, studies show, the virus can travel further, maybe. 23. We count the number of deaths but we don't know how many people are infected as we have only tested so far those who were "almost dead" to find out if that's what they will die of… 24. We have no treatment, except that there may be one that apparently is not dangerous unless you take too much (which is the case with all medications). Orange man bad. 25. We should stay locked up until the virus disappears, but it will only disappear if we achieve collective immunity, so when it circulates… but we must no longer be locked up for that?

Canada: Ontario, Canada reports 564 new COVID-19 cases, 55 more deaths

France: #BREAKING: Some 940 of the 2,300 crew members aboard the Charles De Gaulle aircraft carrier has tested positive for #COVID19, that's approximately 40% of the crew.

US: Washington Post debunks Feb. Washington Post article that falsely claimed theory that coronavirus came from Wuhan lab was "conspiracy" that "had been debunked

AFTERNOON:

New York: NEW/BREAKING: 630 deaths in last 24 hours in NY, per @NYGovCuomo. Up from 606 deaths, in previous 24 hour period, reported on Thursday.

World: The World Health Organization issued a warning Friday about coronavirus testing, saying there’s no evidence serological tests can show whether a person has immunity or not at risk of becoming reinfected.

China: China revised #COVID19 death toll was “done in an attempt to leave no case undocumented,” says WHO (LOL)

Greece: Greek coronavirus patient still tests positive after 40 days even though he has no symptoms

EVENING:

RUMINT (Brazil): Total caos in Manaus João Lúcio Hospital just collapsed! Dead people corpses laying down with people with covid-19. Hospitals in São Paulo near collapse too! Just saw on our TV LINK

Saudi Arabia: NEW: For the third day in a row, Saudi Arabia reports record number of new coronavirus cases.

UK: BREAKING: 1 million doses of a potential #COVID19 vaccine being developed by British scientists are already being manufactured and will be available by #September, even before trials prove whether the shot is effective, the team said on Friday.(What could go wrong?)

US: Around the country, labs and public officials tell @AP that critical shortages in supplies such as swabs and chemicals make it impossible to increase COVID-19 testing to the levels needed to keep the virus in check and reopen the economy.

[thisdaynews]

JUST IN:Full-Text Of Coronavirus Address By President Buhari (with Video)

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JUST IN:Full-Text Of Coronavirus Address By President Buhari (with Video)

ADDRESS BY H.E. MUHAMMADU BUHARI, PRESIDENT OF THE FEDERAL REPUBLIC OF NIGERIA ON THE #COVID19 PANDEMIC SUNDAY 29TH MARCH, 2020 1. Fellow Nigerians,

2. From the first signs that Coronavirus, or COVID-19 was turning into an epidemic and was officially declared a world-wide emergency, the Federal Government started planning preventive, containment and curative measures in the event the disease hits Nigeria.

3. The whole instruments of government are now mobilized to confront what has now become both a health emergency and an economic crisis.

4. Nigeria, unfortunately, confirmed its first case on 27th February 2020. Since then, we have seen the number of confirmed cases rise slowly.

5. By the morning of March 29th, 2020, the total confirmed cases within Nigeria had risen to ninety-seven.

6. Regrettably, we also had our first fatality, a former employee of PPMC, who died on 23rd March 2020. Our thoughts and prayers are with his family in this very difficult time. We also pray for quick recovery for those infected and undergoing treatment.

7. As of today, COVID-19 has no cure. Scientists around the world are working very hard to develop a vaccine.

8. We are in touch with these institutions as they work towards a solution that will be certified by international and local medical authorities within the shortest possible time.

9. For now, the best and most efficient way to avoid getting infected is through regular hygienic and sanitary practices as well as social distancing.

10. As individuals, we remain the greatest weapon to fight this pandemic. By washing our hands regularly with clean water and soap, disinfecting frequently used surfaces and areas, coughing into a tissue or elbow and strictly adhering to infection prevention control measures in health facilities, we can contain this virus.

11. Since the outbreak was reported in China, our Government has been monitoring the situation closely and studying the various responses adopted by other countries.

12. Indeed, the Director General of the Nigeria Centre for Disease Control (NCDC) was one of ten global health leaders invited by the World Health Organisation to visit China and understudy their response approach. I am personally very proud of Dr Ihekweazu for doing this on behalf of all Nigerians. 13. Since his return, the NCDC has been implementing numerous strategies and programs in Nigeria to ensure that the adverse impact of this virus on our country is minimized. We ask all Nigerians to support the work the Federal Ministry of Health and NCDC are doing, led by the Presidential Task Force.

14. Although we have adopted strategies used globally, our implementation programs have been tailored to reflect our local realities.

15. In Nigeria, we are taking a two-step approach.

16. First, to protect the lives of our fellow Nigerians and residents living here and second, to preserve the livelihoods of workers and business owners to ensure their families get through this very difficult time in dignity and with hope and peace of mind.

17. To date, we have introduced healthcare measures, border security, fiscal and monetary policies in our response. We shall continue to do so as the situation unfolds.

18. Some of these measures will surely cause major inconveniences to many citizens. But these are sacrifices we should all be willing and ready to make for the greater good of our country.

19. In Nigeria’s fight against COVID-19, there is no such thing as an overreaction or an under reaction. It is all about the right reaction by the right agencies and trained experts.

20. Accordingly, as a Government, we will continue to rely on guidance of our medical professionals and experts at the Ministry of Health, NCDC and other relevant agencies through this difficult time.

21. I therefore urge all citizens to adhere to their guidelines as they are released from time to time.

22. As we are all aware, Lagos and Abuja have the majority of confirmed cases in Nigeria. Our focus therefore remains to urgently and drastically contain these cases, and to support other states and regions in the best way we can.

23. This is why we provided an initial intervention of fifteen billion Naira (N15b) to support the national response as we fight to contain and control the spread.

24. We also created a Presidential Task Force (PTF) to develop a workable National Response Strategy that is being reviewed on a daily basis as the requirements change. This strategy takes international best practices but adopts them to suit our unique local circumstances.

25. Our goal is to ensure all States have the right support and manpower to respond immediately.

26. So far, in Lagos and Abuja, we have recruited hundreds of ad-hoc staff to man our call centers and support our tracing and testing efforts.

27. I also requested, through the Nigeria Governors Forum, for all State Governments to nominate Doctors and Nurses who will be trained by the NCDC and Lagos State Government on tactical and operational response to the virus in case it spreads to other states.

28. This training will also include medical representatives from our armed forces, paramilitary and security and intelligence agencies.

29. As a nation, our response must be guided, systematic and professional. There is a need for consistency across the nation. All inconsistencies in policy guidelines between Federal and State agencies will be eliminated.

30. As I mentioned earlier, as at this morning we had ninety-seven confirmed cases. Majority of these are in Lagos and Abuja. All the confirmed cases are getting the necessary medical care.

31. Our agencies are currently working hard to identify cases and people these patients have been in contact with.

32. The few confirmed cases outside Lagos and Abuja are linked to persons who have travelled from these centres.

33. We are therefore working to ensure such inter state and intercity movements are restricted to prevent further spread.

34. Based on the advice of the Federal Ministry of Health and the NCDC, I am directing the cessation of all movements in Lagos and the FCT for an initial period of 14 days with effect from 11pm on Monday, 30th March 2020. This restriction will also apply to Ogun State due to its close proximity to Lagos and the high traffic between the two States.

35. All citizens in these areas are to stay in their homes. Travel to or from other states should be postponed. All businesses and offices within these locations should be fully closed during this period.

36. The Governors of Lagos and Ogun States as well as the Minister of the FCT have been notified. Furthermore, heads of security and intelligence agencies have also been briefed.

37. We will use this containment period to identify, trace and isolate all individuals that have come into contact with confirmed cases. We will ensure the treatment of confirmed cases while restricting further spread to other States.

38. This order does not apply to hospitals and all related medical establishments as well as organizations in health care related manufacturing and distribution.

39. Furthermore, commercial establishments such as;

a. food processing, distribution and retail companies;

b. petroleum distribution and retail entities,

c. power generation, transmission and distribution companies; and

d. private security companies are also exempted.

40. Although these establishments are exempted, access will be restricted and monitored.

41. Workers in telecommunication companies, broadcasters, print and electronic media staff who can prove they are unable to work from home are also exempted.

42. All seaports in Lagos shall remain operational in accordance with the guidelines I issued earlier. Vehicles and drivers conveying essential cargoes from these Ports to other parts of the country will be screened thoroughly before departure by the Ports Health Authority.

43. Furthermore, all vehicles conveying food and other essential humanitarian items into these locations from other parts of the country will also be screened thoroughly before they are allowed to enter these restricted areas.

44. Accordingly, the Hon. Minister of Health is hereby directed to redeploy all Port Health Authority employees previously stationed in the Lagos and Abuja Airports to key roads that serve as entry and exit points to these restricted zones.

45. Movements of all passenger aircraft, both commercial and private jets, are hereby suspended. Special permits will be issued on a needs basis.

46. We are fully aware that such measures will cause much hardship and inconvenience to many citizens. But this is a matter of life and death, if we look at the dreadful daily toll of deaths in Italy, France and Spain.

47. However, we must all see this as our national and patriotic duty to control and contain the spread of this virus. I will therefore ask all of us affected by this order to put aside our personal comfort to safeguard ourselves and fellow human beings. This common enemy can only be controlled if we all come together and obey scientific and medical advice.

48. As we remain ready to enforce these measures, we should see this as our individual contribution in the war against COVID-19. Many other countries have taken far stricter measures in a bid to control the spread of the virus with positive results.

49. For residents of satellite and commuter towns and communities around Lagos and Abuja whose livelihoods will surely be affected by some of these restrictive measures, we shall deploy relief materials to ease their pains in the coming weeks.

50. Furthermore, although schools are closed, I have instructed the Ministry of Humanitarian Affairs, Disaster Management and Social Development to work with State Governments in developing a strategy on how to sustain the school feeding program during this period without compromising our social distancing policies. The Minister will be contacting the affected States and agree on detailed next steps.

51. Furthermore, I have directed that a three month repayment moratorium for all TraderMoni, MarketMoni and FarmerMoni loans be implemented with immediate effect.

52. I have also directed that a similar moratorium be given to all Federal Government funded loans issued by the Bank of Industry, Bank of Agriculture and the Nigeria Export Import Bank.

53. For on-lending facilities using capital from international and multilateral development partners, I have directed our development financial institutions to engage these development partners and negotiate concessions to ease the pains of the borrowers.

54. For the most vulnerable in our society, I have directed that the conditional cash transfers for the next two months be paid immediately. Our Internally displaced persons will also receive two months of food rations in the coming weeks.

55. We also call on all Nigerians to take personal responsibility to support those who are vulnerable within their communities, helping them with whatever they may need.

56. As we all pray for the best possible outcome, we shall continue planning for all eventualities.

57. This is why I directed that all Federal Government Stadia, Pilgrims camps and other facilities be converted to isolation centers and makeshift hospitals.

58. My fellow Nigerians, as a Government, we will avail all necessary resources to support the response and recovery. We remain committed to do whatever it takes to confront COVID-19 in our country.

59. We are very grateful to see the emerging support of the private sector and individuals to the response as well as our development partners.

60. At this point, I will ask that all contributions and donations be coordinated and centralized to ensure efficient and impactful spending. The Presidential Task Force remains the central coordinating body on the COVID-19 response.

61. I want to assure you all that Government Ministries, Departments and Agencies with a role to play in the outbreak response are working hard to bring this virus under control.

62. Every nation in the world is challenged at this time. But we have seen countries where citizens have come together to reduce the spread of the virus.

63. I will therefore implore you again to strictly comply with the guidelines issued and also do your bit to support Government and the most vulnerable in your communities.

64. I will take this opportunity to thank all our public health workforce, health care workers, port health authorities and other essential staff on the frontlines of the response for their dedication and commitment. You are true heroes.

65. I thank you all for listening. May God continue to bless and protect us all. [/b] President Muhammadu Buhari

[ayudagtwordpress-blog]

It is always so sad to see puppies and dogs suffer from a preventable disease such as Distemper. It’s even more painful when the poor dog is abandoned due to the illness, like this one.

First off, why would you buy a purebred dog and then neglect to vaccinate him/her? Then be even more irresponsible by dumping the pup on the streets to spread the disease to others!  We hope this little guy makes it through and has a decent quality of life on the other end of this dreadful disease.

The following is an information guide given out by Ayuda interns during humane education presentations. Copies are also made available in the Ayuda offices.

Clinic News:

The team always starts the month in Panajachel where the turnout is never a disappointment. We were fortunate to have lots of volunteers on hand who helped with everything from intake, to puppy sitting, to prep, to recovery, and discharge. The crew included: Emily, Bea, Vicky, Rodri, Betty, Karin, Noj, Jonas, Gregorio, Harold, and Vilma from the Centro de Salud office who gave free rabies vaccinations to all the patients. Here’s what the day looked like:

Cat recovery

Rodri is giving discharge instructions; Vilma is filling out rabies certificates; Bea is handling the discharge instruction sheets; Emily and Jonas were keeping their eyes on the recovery area.

Sky

Dog Recovery Area

Karin keeping Valentina calm

The Kitty Bed

Prep and Surgery Areas

Who remembers Angela from last months clinic in Tzununa? Well, she’s been in foster care with Emily and is doing great! She was at the Pana clinic for sterilization and is scheduled to go to her new home this week! Such an amazing recovery in only 2 weeks.

Taken in Tzununa on 24 October

Taken in Panajachel 7 November

  The second week of the month we head up the mountain to either San Andres Semetabaj or Godinez. This time we were back in San Andres. Sorry…only a few photos this time.

Fresa

Azul. She is a known street dog who is being cared for by friends in San Andres.

Muchas Manchas. Also a known street dog who is being cared for by Noj and Jonas. Turns out to be more complicated than expected. She is back in the hospital to repair a dislocated hip. MM also has an old fracture in her rear spine which can’t be fixed; however, she’ll be feeling better and getting around again soon!

So skinny!

This photo is included to show what happens when dogs are chained for long periods of time. Note her broken bottom teeth.

Along with Ayuda’s regularly scheduled sterilization clinics, our volunteers have been busy rescuing puppies which will be up for adoption soon and grabbing female dogs in heat off the streets of Panajachel. This week we hope to nab some of the male dogs who are causing problems due to the in heat females. The majority of these males are well-fed and in decent shape. They have people who are behaving irresponsibly by not keeping their intact (non-castrated)  male dogs at home.

This little beauty was picked up near the dock in Panajachel on Friday.

In-heat Dulce and Coco were also taken in for sterilization this past week. Each of these dogs must spend a week in the hospital or in a secure foster home to allow their hormonal scent to dissipate. If they are released too soon, the male dogs will still mount them which causes HUGE problems for the females.

Adoption News

If you are interested in adopting a dog or cat, please contact us. Animals in need of their permanent homes are advertised on the Ayuda Facebook page as soon as they are ready to go!

Humane Education News

Ayuda intern, Stephanie Garcia now appears on channel 6 television once a month and  on Radio Solola 88.7 twice a month.

In last week’s radio show, Stephanie talked about abuse and neglect as well as how to report these problems. Ayuda has received many calls over the last several months from concerned residents who wanted to intervene on behalf of the animals.

Monday 25 November Stephanie will be on television at around 5 pm to discuss this problem in more detail. Tune into to learn how you can help!

When it is a situation with a person’s neighbor, Ayuda volunteers first try talking with the people involved to try to resolve the issue without involving the authorities.

When it is a problem larger than our volunteers are willing to handle the neighbors are given copies of the form needed to request an investigation by the federal agency, Unidad de Bienestar Animales (UBA). These complaints can be made anonymously.

Last Monday Stephanie gave a presentation on basic animal care to a group of Panajachel residents. Thank you to Lily Cana for coordinating and Hotel Porto del Lago for sponsoring this event.

Emergency Services News

One of Panajachel’s most adored dogs had to go back in for a second surgery to remove another skin tumor. Dr. Isael sent off a biopsy to check for carcinoma, an aggressive skin cancer. We all hope this comes back negative!

Sugar lives in Jucanya, a barrio of Panajachel. She is cared for daily by our good friend, Kelly A. and will recover for the next week with Mina O. Thanks, ladies!

Another little guy who was allowed to roam free and was hit by a car. His family can’t afford to pay the full price for his treatment, so Ayuda will subsidize 1/2 of his vet bill. He will no longer be allowed to be out on his own.

There are several other cases which fall under emergency services but the photos are too gruesome to share. Our funds for these emergencies and boarding for the in-heat females are always low because we depend upon private, individual donors to cover these costs.

Your donations make this work possible.

Please make yours today by clicking HERE.

    The Ugly Face of Distemper & Other News It is always so sad to see puppies and dogs suffer from a preventable disease such as Distemper.

[juniperpublishers-yoga]

Benefits of Preoperative Exercise Therapy in Surgical Care; it Does Work, but how do we Need to Continue?-Juniper Publishers

For more articles in  Journal of Yoga and Physiotherapy please clickon https://juniperpublishers.com/jyp/index.phpFor more Journals in Juniper Publishers please click on https://juniperpublishers.com/index.phpTo know more details regarding our Juniper publishers please click onhttps://juniperpublishers.business.site/Juniper Publishers- Journal of Yoga and Physiotherapy

Opinion

Preoperative physical function is shown to be an independent predictor of post-operative morbidity and mortality [1-3]. Surgical stress often leads to a substantial decrease in physical functioning through different pathways. In addition, prolonged periods of physical inactivity in the postoperative phase induces loss ofmuscle mass, cardiopulmonary deconditioning, pulmonary complications and psychological distress. These phenomena may result in a decreased quality of life postoperatively, increased morbidity and occasionally premature death [4-7].

In terms of cancer, most forms are prevalent in an elderly population that mainly unfit to undergo major surgery. Lung cancer for instance is one of the leading causes of cancer death worldwide [8]. It is frequently diagnosed at a late stage due to its initial asymptomatic course often leading to a poor prognosis. Surgical removal remains the best [curative] option for patients with stage I and II Non Small Cell Lung Cancer [NSCLC] and for selected patients with locally advanced disease [stage IIIA] [9]. However most patients selected for surgical removal have limited functional capacity, owing to associated comorbidities and/or the stage of the disease [10]. As preoperative physical capacity predicts postoperative recovery, especially in elderly patients, a substantial body of research is directed towards studying the effects of various regimens of Preoperative Exercise Therapy (PET) [11-14]. A number of postoperative outcome measures such as complication rate, length of hospital stay and time of convalescence were previously reviewed [15-17]. However, based on these reviews univocal conclusions cannot be obtained, in terms that PET is able to significantly reduce postoperative complications. PET has been identified as a successful therapy to improve overall physical and psychological well being in some cancer populations [mainly breast cancer] [18]. There is increasing evidence in the field of lung surgery [19-21] and also in other surgical specialties [15,17,22] that a preoperative exercise therapy (PET) program has beneficial effects on the postoperative course, especially on the prevention of postoperative complications, the length of hospital admission, physical fitness and quality of life. With such an increasing body of evidence, why aren't we able to further implement these PET programs in our daily practice? This review will address several aspects.

Definitions of exercise physiological variables

In exercise physiology different terms are used to describe and measure the effect of a PET program. For describing those effects two different terms are often used, physical activity and physical fitness [23]. Physical activity is defined as any bodily movement produced by skeletal muscles, which results in energy expenditure, which can be measured in kilojoules (kJ) or kilocalories (kcal) [23]. Physical capacity/fitness or 'being physically fit' is defined as: 'the ability to carry out daily tasks with vigour and alertness, without undue fatigue and with ample energy to enjoy leisure-time pursuits and to meet unforeseen emergencies [23]. For measuring the effect of PET programs, themost widely used parameters areventilatory threshold and VO2 peak [24]. VO2 peak is defined as the highest value of VO2 attained at a maximal incremental exercise test [24]. The ventilatory threshold is the point during exercise at which pulmonary ventilation becomes disproportionately high with respect to the oxygen consumption. This point is believed to be the onset of usage of the anaerobic pathway (anaerobic threshold) [24].

Implementing problems

There is promising evidence for the effect of PET, but currently there are three problems when appraising the studies performed: 1) heterogeneous patient populations; 2) noncomparable PET programs and 3) lack of guidelines for the use of PET programs and reported outcome measures. The heterogeneity of PET programs makes comparisons difficult and according to several studies [15,25-28] it is not evident as to what the optimal exercise programs should be for this patient population. The timing around surgery is also a point of discussion. Preoperative exercise and postoperative exercise should be considered as separate entities mainly due to the time period available and the physical status of the patient in each setting [29].

Due to the small preoperative time period (from diagnosis to surgery), PET programs were shorter in duration (maximum of 4 weeks) and more intense in prescribed sessions a week to enable the maximum possible benefit. An example is study 1 of Benzo et al. [30] the presumed PET program was to long and health professionals were not willing to delay the surgery date. Studies investigating postoperative exercise programs have a much longer time period [21,29,31-34]. A shorter exercise program with a higher frequency of exercise sessions can be a problem for the relatively unfit patients. In a study of Jones and colleagues is described that their short and intense exercise program may have worsened fatigue due to its intense and demanding nature in a population that was deconditioned and had significant comorbidity [35]. So far the majority of the included studies use the physical activity guidelines for adults, which recommends exercise sessions of 30 minutes five times a week [36].

It is evident that the setting of the exercise intervention (PET or postoperative exercise) is an important influencing factor. Inpatient studies frequently had supervision during the exercise sessions. It remains questionable if this is feasible in an outpatient setting, due to costs and because of the fact that travel (distance) is an important barrier for attending an exercise session [37,38]. Realistically due to the financial aspects, home- based or outpatient studies may be more manageable in the longer term. Also, in a review by Dalal et al. [37] it was described that home-based cardiac rehabilitation programs have superior adherence rates than centre-based programs.

Adherence/Participation

In cardiac rehabilitation, exercise interventions are the cornerstone of rehabilitation but participation rates remain low. This might be due to three barriers that have been identified in the literature regarding participation; service and system level barriers (physician recommendations and misconceptions about the rehabilitation program], practical barriers (transport and parking), and personal barriers (perceptions of the ability to control the disease) [29,38]. In future research these barriers have to be taken into account to develop a more suitable interventions, which will result in higher adherence rates.

Exercise capacity

Exercise capacity, measured with the VO2max, is an important consideration in decision-making whether a patient is suitable for surgical resection. Peak VO2 max is reported as the strongest independent predictors of surgical complications [39]. Poor exercise capacity has been shown to be a major determinant of morbidity and mortality after lung resection surgery [40-42]. Therefore interventions aimed to improve the exercise capacity and VO2max might lower postoperative complications, length of stay and costs of hospital admissions [15,22,29,43-45]. Interestingly, several of the included studies showed that recruited patients who had impaired exercise capacity at baseline (VO2max <15ml/kg/min) [46-49], were those who benefitted the most from the exercise intervention.

Directions for future research

The goal of a PET program is to prepare patients for surgery in the best possible way with the objective to reduce postoperative complications, length of stay, and the healthcare costs. The results seem promising, but a necessity for future research remains. To be able to perform high quality research in the near future, definitions of PET, including timing, (acceptable) duration, intensity and exercise training methods should be determined and compared. Also the effects of PET need to be studied in specific patient groups, per example patients with COPD compared to patients without COPD (both scheduled for lung resection surgery). Future improvements in standards of care and optimal pre-operative preparation should not only focus of the surgical team and the hospital organisation but also on incorporating the active role of the patient.

For more articles in  Journal of Yoga and Physiotherapy please click

on https://juniperpublishers.com/jyp/index.php

For more Journals in Juniper Publishers 

please click on https://juniperpublishers.com/index.php

To know more details regarding our Juniper publishers please click on

https://juniperpublishers.business.site/

[your-dietician]

The Latest: Romania's Capital Marks a Day Without New Cases | Health News

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The Latest: Romania's Capital Marks a Day Without New Cases | Health News

BUCHAREST, Romania — Romania’s capital did not record any new coronavirus cases on Sunday, officials said.

Just a few months ago, Bucharest’s intensive care units were stretched to maximum capacity as its 14-day accumulative infection rate topped 7 per 1,000 inhabitants. Now the capital’s infection rate — the same as the country as a whole — stands at just 0.05 per 1,000 inhabitants.

“Bucharest has the highest vaccination rate in the country,” Prime Minister Florin Citu wrote online Sunday. “Also in Bucharest, in the last 24 hours we had 0 (!!!) infected people with SARS-COV2. Vaccination is the only solution to overcome the pandemic. It is that simple!”

Romania’s vaccination drive has seen nearly 9 million vaccine doses administered in the country of more than 19 million, but there are now concerns as daily vaccine doses administered have slowed dramatically and just 23% of the country’s population are fully inoculated against COVID-19.

Political Cartoons on World Leaders

Political Cartoons

Since the pandemic started 1.08 million people in Romania have tested positive for COVID-19 and more than 33,000 have died.

— Bangkok, 9 provinces restrict movements to curb rising cases

— Parts of Sydney going into lockdown as virus outbreak grows

— As variant rises, U.S. vaccine plan targets ‘movable middle’

— Bruce Springsteen marks the return of live shows on Broadway

— In pandemic, drug overdose deaths soar among Black Americans

— U.S. states hesitant to adopt digital COVID vaccine verification

Follow more of AP’s pandemic coverage at https://apnews.com/hub/coronavirus-pandemic and https://apnews.com/hub/coronavirus-vaccine

HERE’S WHAT ELSE IS HAPPENING:

ROME — Italian health and regional officials are urging people to leave for vacation only after they are vaccinated, as the delta variant of COVID-19 is becoming more prevalent in the country.

Virus experts in Italy are sounding warnings that the virus with that variant is more transmissible and less sensitive to COVID-19 antibodies.

Italians in some places are increasingly not showing up for their second vaccine dose, or even keeping first-dose appointments, as holiday season gears up.

Gov. Vincenzo De Luca of the Campania region, which includes Naples, is warning that if the metropolis’ vaccination rate doesn’t improve, a new lockdown could be ordered after summer.

So far, about 30% of people in Italy have completed COVID-19 vaccination.

In the nation of 60 million people, doctors are particularly worried about the 2.7 million persons older than 60 who haven’t signed up to receive a first dose.

Starting Monday, mask-wearing will no longer be required outdoors, except in crowded situations or where it’s impossible to keep a safe distance.

TOKYO — Tokyo’s governor, who has taken time off since last week due to severe fatigue, needs to rest several more days this week, the metropolitan government said Sunday, as experts warn a resurgence of the infections less than a month before the capital city hosts the Olympics.

Gov. Yuriko Koike has been resting since last Wednesday due to severe fatigue. She was to rest until Sunday but Tokyo metropolitan officials said she will be off several more days. She has been deeply involved with preparations for the Olympics and Paralympics as well as leading the capital’s coronavirus response. Officials refused to confirm media reports that Koike has been hospitalized.

After one year postponement, the Olympics will begin on July 23. Last week, Olympic officials decided to allow the public to attend the Games, though caps were set on spectators. Health experts have expressed deep concern the Games could cause the virus to surge in the Tokyo region.

Japan last week eased a state of emergency in most other areas, but daily new cases have already been rising back in Tokyo, and experts have warned of further increase of the infections as the Delta strain of the virus spreads.

Tokyo on Sunday reported 386 new cases, up from 376 a week earlier as the capital makes a week-on-week increase for a eighth consecutive day. Japan had 794,457 cases and 14,657 deaths as of Saturday.

JERUSALEM — Israel’s new prime minister is urging the country’s youth to get vaccinated as coronavirus case numbers have crept up in recent days due to a localized outbreak of the Delta variant.

Naftali Bennett’s comments came at a meeting of the government Sunday in Jerusalem.

“We don’t want to impose any restrictions: not on parties, on trips or anything like that. But specifically because of this, if you don’t want restrictions, go get vaccinated today. Talk to your parents and get vaccinated,” he said.

Israel reinstated a mask mandate indoors amid a rise in new infections in the past week. Israel’s Health Ministry recorded 113 new coronavirus cases Saturday.

The prime minister also says the government has appointed a special director in charge of managing the country’s border crossings — with particular emphasis on Israel’s main international airport — and preventing the spread of the coronavirus and other diseases.

Bennett said the appointment of Roni Numa, a former army general, aims to step up the country’s efforts “to prevent the entry of this virus and variants and other future viruses from around the world into Israel.”

Many of the new cases reported in the past week were traced to individuals who had arrived from abroad.

KUALA LUMPUR, Malaysia — Malaysia’s leader says the country will indefinitely extend a near-total lockdown that’s been in place for a month, as coronavirus infections remain high.

Prime Minister Muhyiddin Yassin on Sunday said the lockdown won’t be eased unless daily new cases fall below 4,000, the vaccination rate reaches 10% and demand is reduced for intensive care in hospitals. The national Bernama news agency quoted Muhyiddin as saying he hopes this will happen by mid-July.

The lockdown was set to expire Monday.

Daily new cases have stubbornly stayed above 5,000, with the Health Ministry on Sunday reporting 5,586 new infections, taking the country’s tally to 734,048 cases and nearly 5,000 deaths.

Only 6% of Malaysia’s 33 million people have been fully vaccinated so far, but the government has stepped up vaccination efforts.

Malaysia halted most economic and social activities since June 1, after daily cases shot up to more than 9,000 cases.

It was the second nationwide lockdown in over a year and is expected to hurt its economic recovery. The World Bank has cut its growth forecast for Malaysia to 4.5% this year, from an earlier estimate of 6%.

GENEVA — The head of the World Health Organization lamented the lack of coronavirus vaccines being immediately donated by rich countries to the developing world.

WHO director-general Tedros Adhanom Ghebreyesus said Friday that there was nothing to discuss during a recent meeting of an advisory group established to allocate vaccines.

In his words: “There are no vaccines to allocate.”

Tedros says concerns being raised by some donors that African countries don’t have the infrastructure to deliver vaccines or that there are vaccine hesitancy problems are inconsequential. He criticized rich countries that may be using that as a “pretext” not to donate vaccines.

RALEIGH, N.C. — In the two weeks since the state of North Carolina announced four $1 million prizes would be given out to vaccinated adults, less than 118,000 residents, about 1% of the state population, came in for a first dose.

Less than half of North Carolinians eligible for a coronavirus shot are fully vaccinated, even though there are more than 2.1 million doses waiting on shelves for residents to take.

North Carolina ranks 12th worst in the nation in vaccines administered per capita, according to data from the U.S. Centers for Disease Control and Prevention.

GENEVA — The head of the World Health Organization said the COVID-19 variant first seen in India, also known as the delta variant, is “the most transmissible of the variants identified so far” and that it is now spreading in at least 85 countries.

At a press briefing on Friday, WHO director-general Tedros Adhanom Ghebreyesus said the U.N. agency was concerned about it’s the increasing reach of the delta variant, particularly among unvaccinated populations.

“We are starting to see increases in transmission around the world,” Tedros said, adding that “more cases means more hospitalizations…which increases the risk of death.” WHO has previously said that two doses of the licensed COVID-19 vaccines appear to provide strong protection against the variant first seen in India, but warned the lack of access to vaccines in poor countries — which have received fewer than 2% of the billion doses administered so far — makes them extremely vulnerable.

Tedros also said the unchecked circulation of the coronavirus could lead to the emergence of even more variants.

“New variants are expected and will continue to be reported,” Tedros said. “That’s what viruses do. They evolve,” he said. “But we can prevent the emergence of variants by preventing transmission.”

AMSTERDAM — The European Medicines Agency has approved a new manufacturing site for Johnson & Johnson’s COVID-19 vaccine, in a move that should boost production of the one-dose vaccine across the 27-nation EU.

In a statement Friday, the EU drug regulator said the new site in Anagni, Italy, will finish manufacturing of the J&J vaccine, which was licensed for use in adults across Europe in March. Production problems have stalled J&J’s roll-out across the European Union in recent months and millions of doses made at a U.S. factory had to be thrown out after contamination issues.

The EU has ordered 200 million doses of the J&J vaccine and was expecting 55 million by the end of June; to date, fewer than 14 million doses have been distributed.

J&J’s vaccine roll-out was also stalled after the EMA concluded there was a “possible link” between the coronavirus shot and very rare blood clots and recommended that a warning should be added to the label. Health officials say the vaccine’s benefits still far outweigh the risks.

Copyright 2021 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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[ourhaileydavies]

Chiari Malformation Type III with Good Outcome: Case-Report and Review of Clinical and Radiological Findings-Juniper publishers

Abstract

Chiari III malformation, one of the rare variants of Chiari malformations, is including a small dysplastic posterior fossa, hydrocephalus, medullary abnormalities, and hindbrain herniation into a low occipital/high cervical encephalocele. This type can be lethal if not treated and is related to severe neurological deficits, so surgical care should immediately be undertaken. We are presenting a 1.5-month-old male infant with Chiari III malformation that was managed surgically with good outcome in addition, review the radiological, clinical and pathogenesis of Chiari III malformation.

Introduction

Type III Chiari malformation is a very rare condition that is described by Chiari in 1891.This type of Chiari defined as hindbrain herniation into a high cervical encephalocele or low occipital, and osseous defects with features of type II Chiari malformation (including a small posterior fossa, herniated dysplastic posterior fossa content, hydrocephalus, medullary kinking, and tectal beaking) [1-5]. In literature, approximately 60 cases have been reported since 1891 to have Chiari III (Table 1).

Chiari III malformation is related to early mortality, if not being treated. Since it has a poor outcome, it is related to severe neurological deficits, developmental delays, and seizure in long term, if being survived [6]. We are presenting a 1.5-month-old case of Chiari type III that was managed surgically with good outcome. In addition, review the pathogenesis, radiological, and clinical features of Chiari III malformation.

Case

A 1.5-month-old male infant presented to hospital emergency department with complaint of large congenital occipital mass. He was born at full-term, as the product of normal delivery, second child of a low socioeconomic non-consanguineous parents. There was no history of medication or maternal infection. The mother had no history of use of iron products, too. On examination, the child had 3350gr weight (wt.), 32 cm head circumference (H.C.) at birth, and 4000gr wt., 36cm H.C. at the day of admission. He had no neurological deformity or cranial nerve palsy, and had normal eye movement with no nystagmus. Spontaneous movements of all extremities were present. All reflexes were normal. Chest was clear, with normal breathing sound. There was a soft, 6*5cm trans-illuminate mass in occipital and upper cervical region, which was tense on crying and was covered with thin skin (Figure 1). There was no cerebrospinal fluid (CSF) leakage. There was no history of fever or discharge from the mass. The biochemical and hematological parameters were normal.

Magnetic Resonance Imaging (MRI) was performed on a 1.5T MR scanner and revealed a bony defect (approximately 2*2cm) in the occipital and upper cervical (C1-C2 vertebrae) region that had an encephalocele with partial herniation of the cerebellum and a part of the brainstem. There was no hydrocephalus (Figure 2-5). No tethering or syringomyelia was revealed in screening MRI of the lumbar spine.

After general anesthesia, the patient was turned prone. The skin over the mass was incised in midline and was dissected around the mass. Below the skin, the covering dura was seen. Suboccipital craniotomy was done. On opening the dura, herniated cerebellum was seen in the sac (Figure 6). Cord and brain steam was untethered and cranio-cervical junction adhesions were released. There was no need for ventrico- peritoneal shunt. Secondary closure of the dura was done with the pericranial patch. The child was extubated in the recovery room. Early post operation and on the fifth day brain computed tomography (CT) scan was done that didn't show hydrocephalus. Examination of lower cranial nerve was normal. Postoperative imaging revealed well positioned brain steam and cerebellum (Figure 7). Patient was discharged a week after surgery. Till now, 1 year after surgery, patient has good outcome with normal developmental and neurological examination.

Discussion

Hans Chiari, described and characterized hindbrain deformities as the Chiari malformation in 1891 [5]. One of the rare variants is Chiari malformation type III, that is characterized by osseous defects and occipital or high cervical encephalocele and some anatomical characteristics of Chiari malformation type II, including a small posterior fossa, herniated dysplastic posterior fossa content, hydrocephalus, medullary kinking, and tectal beaking [1-4]. Chiari malformation type III has poorer outcomes that type I and II, and those who survive develop with developmental delays and severe neurological deficit [6].

Till now, the pathogenesis of Chiari malformation type III remains unclear, but Chiari believed this variant was due to hydrocephalus [5]. Some have suggested that primary abnormal mesodermal defect is related to this type [7]. Some authors have stated that during intrauterine period, escape of CSF from an open neural tube defect has caused destination of primitive ventricles and small skull, like what happens in Chiari II malformation [8]. Others believe that caudal displacement of hindbrain and hypoplastic posterior fossa are the result of lack of distension of the embryonic ventricular system secondary to abnormal neurulation [4]. Others have posited that failure of ossification centers to fuse completely or failure of induction of endochondral bone by incomplete closure of the neural tube are responsible for bony defects and encephalocele [4,9]. Finally, some believe that mesenchymal development disturbance in embryological life is the secondary event in Chiari III malformation and the underlying problem is likely to be the deranged CSF dynamics [10].

Chiari III malformation incidence is 0.65-4.4% among all of the Chiari malformations [11-13] and have been diagnosed prenatally to 14-years-old [4]. The most common to the least position of encephalocele are low occipital/high cervical [14,15]. Symptoms are strongly related to the amount of herniated brain structures, ranges from asymptomatic in those with only bulging in the back of the head [16] to clinical findings like downbeat nystagmus and titubation, ataxia, sensory loss, respiratory failure, hyperreflexia, spastic muscle or hypotonia, and inspiratory stridor [17,18].

Occipital bone defects are seen in some, but not all Chiari III malformations [19], and 70% of cases have been reported to have incomplete fusion of the posterior arches of C1 [4]. Contents of encephalocele in Chiari malformation III is usually nonfunctional and contains necrosis of neural tissue, gliosis, fibrosis, meningeal inflammation, cerebral or cerebellar tissue, ventricles, and reactive astrocytes [6,15]. Cerebellum, occipital lobe, and parietal lobe are the most to the least common parts of brain occurring in the sac. Ectopic venous sinuses and aberrant deep veins are common [15]. Other anomalies of the brain are including posterior falx cerebri aplasia, lack of cerebellum, posterior petrous pyramids and the clivus scalloping, syringomyelia, and creeping of the cerebellar hemispheres around the brain stem [4,15]. Though hydrocephalus is not an essential finding, has been reported in 88% of the cases [6]. Syringomyelia is commonly present [16,18].

Ultrasound has been used antenatally, the earliest report is at 18 weeks of gestational age (WGA) [20], to identify cranial anomalies [3,21]. Elective C section is the standard plan of delivery when encephalocele diagnosed [20]. MRI is the modality of choice and can identify the amount of brain occurring in the encephalocele [6,15], and is used prenatally after abnormalities were seen on fetal ultrasound [20]. Though occipital/cervical encephalocele is not necessarily associated with a poor prognosis, Chiari III malformation can be lethal if untreated, so surgical care should be undertaken.

Time of surgery remains controversial, some believe that immediate closure of the defect is the ideal treatment while others believe if the sac is covered with normal skin, it is rarely needed to perform surgery urgently [6,16], but primary closure remains the treatment of choice [6,15]. Preserving neurological function while as much as possible neural tissue in the encephalocele is resected, reconstruction and repair of dura, and preventing future tethering are the goals of surgery [6,15]. Some authors report placing a temporary external drain [1], or a shunt before encephalocele closure [22-24]. Overall mortality rate is 29% [7,25], and postoperative mortality accounts for 22% of all mortalities [15]. Neurological function outcomes depend on the neurological status before surgery [24]. Positive prognostic factor is less than 5cm of herniated brainstem [6], and hydrocephalus, neural tissues in the sac, large size of sac, and intermittent respiratory stridor are the negative prognostic factors [7,18].

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[protego-et-servio]

I had an abortion in the summer of 2013, after much debate.  My girlfriend (trans woman, pre-HRT) and I were not in a position for another child.  A third child would have meant the necessity for a bigger apartment, a car that could hold three car seats, money for baby essentials, and a budget that was much bigger than what we had.  In order to keep a roof over our heads and food in our bellies, termination was the best option.

After finally deciding abortion was for the best, I still dilly-dallied for a couple of weeks, hoping for something to drop into our lives to make everything peaches and cream.  Eventually, I realized that my hesitating was an act of selfishness; I only waited, because I was afraid of the procedures and afraid of the stigma.  The longer I waited, the more expensive it would be or, if I had kept putting it of, I could have passed the 20 week ban.  I finally scheduled the appointment.  Due to limited clinics in the area, I had to schedule three weeks out.

The day of the abortion, we had no one to watch the kids.  I went alone while my girlfriend stayed home and watched our daughters.

The first step was getting an ultrasound.  The nurse asked me if I wanted to see it, I said no.  She also asked if I wanted a picture, I declined again.  As she used the ultrasound, confusion dotted her face.  She looked to the papers that contained my information and back to the ultrasound.  I thought I was nine weeks along, but I was actually twelve weeks.  (An easy enough mistake to make.)

I intended to get the pill, however the cut off for that is nine weeks.  At twelve weeks, if I still wanted the abortion, I had to get an in-clinic procedure.  This meant I would need to be dilated and have the fetus aspirated/vacuumed out of my uterus.

The thought of getting an invasive procedure frightened me, but I was firm in the knowledge that an abortion was the best for my circumstance.  I agreed to the in-clinic procedure and the rest of my appointment continued.

After the ultrasound, I had to get some blood drawn from a fingertip.  Then I was sent to watch a video, so I understood that I had more options available if I wanted them.  After the video, I sat in the waiting area until I could talk to a counselor.  She made sure my choice was my own, that I wasn’t being forced, and then asked if I’d like to get onto birth control, once I affirmed I wanted an abortion.  There was some discussion on birth control and I decided to get on the pill.

Once my counseling session was complete, I was prepped for the procedure.  Since I had no one to drive me home, I wasn’t allowed pain medication that had a drowsy side effect.  The nurses still gave me a shot in the hip, which would help with the cramp-like pain from dilation, and an antibiotic, as a precaution for any possible infections.

Once in the procedure room, I had a nurse by my side the whole time.  She was marvelous and kind.  She told me what was going to happen, in detail, and confirmed that there would be intense cramping during dilation, but she made it clear I could hold her hand if needed.  As soon as the doctor came in, he shook my hand and smiled and told me he’d try to make it quick and as painless as possible.

After that, he started his preparations.  He did a pelvic exam on me then injected a shot into my cervix to numb it.  Then he used dilators – which are metal rods of varying thickness – to open my cervix.  This part caused the most discomfort/pain, but it wasn’t unbearable; I clung to my nurse’s hand and she wiped my tears away.  It felt like very severe menstrual cramps.  I focused on breathing in through my nose and out through my mouth.

Again, due to being alone, I wasn’t able to get any pain medication that could make me drowsy on the drive home.  If you are considering abortion, and you’re afraid of pain, I urge you to have someone with you.  It’s good for support and you’ll be allowed better pain medication.

When he inserted the suction to clean out my uterus, it was – again – uncomfortable, in the sense it felt odd.  By this time, though, I knew I was in the home stretch.

The procedure took about eight minutes.  After the it was over, I was given a pad for bleeding and my nurse helped me with my clothes before taking me to the recovery area.  I sat down in an armchair and my nurse gave me a heating pad and placed a blanket over me.  I was given crackers to eat, my pain medication to take home, and the contraceptives I requested.  I was in recovery for thirty minutes, after which I reported how much bleeding I had – a small blot, smaller than a dime – and had one last blood pressure test.  Once everything checked out, I was allowed to go home.

Along with my bag of goodies, there was a pamphlet detailing complications to be aware of and a 24/7 emergency number I could call.

The entire time, everyone smiled and was friendly.  They genuinely made me feel cared for.

The realization of how much they helped me hit me once I got out to my car.  Tears started to roll down my face as I clutched this little paper bag with pain meds and birth control.  In other states, there would have been screaming masses outside the clinic, snarling and pointing crooked fingers my direction while calling me a “murderer.”  In other places, the doctor and nurses who helped me would have been the target of vigilantes and harassment.  That takes so much compassion, so much bravery, to do what is right, despite the dangers.

My tears weren’t a sign of sadness or regret.  They stemmed from relief and surprise.  I was, and am still, stunned.  Everyone in that Planned Parenthood had so much compassion, so much kindness.  None of them needed to know why I was there, just that I was there and they were going to help, whatever way I needed.

You never realize how badly you need a hand, until a stranger offers theirs for your comfort.

Now that I’m seven months later, I’d like to add that I’ve never felt regret for my abortion.  I have felt sad, but that’s not the same as regret.  It was a sad choice for me to make, but it was necessary and it was the best option for me and my family.  I’m proud to have the experience and happy to share it with anyone who needs, or wants, a detailed account.

[animalsoffarmsanctuary]

Pickles: I Will Survive!

One of the farm animal species that is hardest to place, introduce into existing populations, and care for financially is also one of the species we get the most calls about, especially over the past few years: the pig. The majority of recent instances have involved people who wanted to raise a pig in their home, so went out and bought a piglet and then discovered that this is not the best idea. But we will save that discussion for another day.

It is easy to understand the draw to a piglet, but remember — 2 pounds goes to 250 pounds in no time at all. And when full grown, a farm pig female can weigh well over 600 pounds — not so great in the house. 

Pickles’ story was not that — although she did live in a home for a few short days while arrangements were made for her long-term care. Pickles was born on a farm, and a friend of a friend was notified when it was discovered that a mother had given birth to a litter in which all of the piglets were born dead except one — a tiny little 2-pound baby.

An exhausted and sickly little Pickles, just a few days old, with her rescuers. 

And thankfully, this friend of a friend could not let Pickles perish, with the mother pig showing no interest in nurturing her offspring. So this amazing and very tiny little bundle of piggy cuteness, named Pickles by her rescuer, came to Farm Sanctuary’s New York Shelter.  

Thankfully, she took quickly to her bottle and had a good appetite.

Her new family gave her a few days of care while trying to find permanent arrangements, but always knew that they could not keep her (although they were very attached). And it’s fortunate that Pickles arrived at Farm Sanctuary when she did — for this was not a healthy pig.

Pickles is very lucky that her new people stepped in when they did, or she too, like her siblings, would have perished. Here she is sleeping and finally feeling safe. 

Pickles had an umbilical hernia and needed surgery, both to clean up the infection and to attempt (for the first time — many more followed) to close the tiny opening in her body cavity. The smaller hernias can actually pose more of an issue than larger ones, with the slippery little intestinal tract getting into the tiny hole and strangulating. This can quickly become fatal, since the those strangulated portions of the intestines die. 

Pickles on day one at her new sanctuary home, getting bottle-fed by our placement coordinator Ashley Pankratz!

Mealtime for baby Pickles!

Pickles finally at Farm Sanctuary — and using some of the beautiful donated blankets we’ve received from our members. Thanks for the warm blankies!  

Pickles getting to know a few of her new human friends, including caregiver Amy Gaetz!

So surgery #1 was an emergency. Pickles was not able to poop, and there was concern that the intestines might be trapped in the tiny hernia pouch. Under anesthesia, it was confirmed that they were, and the hernia was repaired — thankfully, just in time. 

Cleaning the very infected umbilical area — and as you can see, Pickles at just a few days old had no problem protesting this treatment. 

Besides the hernia, she also had navel ill — caused by receiving no colostrum from mom — so she was septic. So her surgery included removing the entire umbilical stump. Coming out of anesthesia, she also had a seizure — this was very scary.

Pickles with belly band — and none too happy about it. The band was not comfortable, but it was the only thing keeping her intestines from getting caught in the tiny hole in her body cavity. 

So home she came after two weeks of recovery and care in the hospital — but in that time, she had gained only two pounds. She was not handling food well at all. And she is a piglet — they do not stand still, even in the tiny enclosure we created for her for just that purpose, complicating the recovery process. So in less than two days, our tiny bundle of energy herniated again. 

So she had surgical repair #2 and came home again — this time with a belly band — and she was also finally gaining some weight (she’d grown from 4 to 7 pounds). 

Applying the belly band, and a very pissy Pickles looks on in frustration.

And besides that belly band — which had to be changed regularly so we could check her incision site — she had to stay still and calm.  

Pickles had to take lots of meds — and sadly, you cannot keep a crazy piglet down.

So I could bore you with the multiple herniations, but suffice it to say that the trouble continued, and finally the hernia was very large — allowing the intestines to easily go into this opening. This too is not ideal — since if they were to get caught on something, that hernia could open and there would be nothing holding her insides in if that were to happen. So more small stall rest, more belly-band changes, and more angry Pickles.

“Get me out of this box!” Pickles had to have a very small, confined pen to keep from opening up her hernia even further. But even a small area could not stop this little jumping bean from staying active. 

But health-wise, the stall rest and belly bands paid off, and her body healed on its own without surgical intervention. It was like a miracle. And Pickles was thrilled. She was allowed to play — run — and all this belly-band free. Psychologically, however, she has a few issues. 

“Hello Amy — what will you be feeding me next?”

We knew that she was a bit of a nipper, which is not unusual with bottle babies, but her nips were pretty significant. We then heard that, as a tiny 30-pound pig (during hospital stay #5), she attacked some of her doctors. Pickles, Pickles, Pickles. 

Even as a baby, Pickles loved to bite, but at first it was cute — and did not hurt. 

So, perhaps due to her stay in solitary (necessary for her survival, of course), she also shows signs of having porcine stress syndrome, which is likely the cause of her hyperthermia (her temperatures was 106.8° Fahrenheit) and seizure coming out of anesthesia. Could it be that having a girdle-like belly wrap that had to be constantly changed did it? But no matter — Pickles is not really predictable, and we are hoping she grows out of this, like most pigs do.

Pickles just last week — checking out the white stuff!

She has a bit of an edge. She is also a herd animal, and up until this week, knew nothing about other pigs and likely felt that humans were her herdmates. Remember that piglets establish hierarchy within the first 24 hours of life — so this makes sense. Attack now and get your place in the rankings — and if we are her herd, she really is just doing what comes naturally. 

Pickles is mocking me. Seriously mocking me.  

So this week we introduced her to someone who also needs a friend — a family and a herd: Mouse! 

Pickles meets Mouse!

And although they are still working things out, they now have each other — and she finally seems to realize that she is indeed a pig. And she can help Mouse with his physical therapy. (Stay tuned for a whole blog post update on Mouse!)

Checking out Mouse’s chute and giving it two hooves up!

And although National Pig Day was yesterday, we are going to finish out the week celebrating these amazing, intelligent, sensitive beings — because really, every day is pig day here at Farm Sanctuary!

You can’t hide a camera from Pickles — so don’t even try!

[mystichoneybuddhachips]

Hi... Um, if you're still doing imagines, I was wondering how the RFA members would deal with MC getting really sick with an internal infection after ignoring the pain for a few days -thought it was a pulled muscle or something-, and going into the ER and having to be pumped an IV of heavy-duty antibiotics before being allowed to go home with a list of prescriptions to take -like antibiotics, pain meds, nausea pills-, and instructions on how to get rid of the infection. Thank you.

dang this was thought out LOL I LOVE IT but i don’t know a lot on infections and medical stuff so i’m just going with it bear with me

Yoosung

the worst part for him was that he wasn’t even with you when it happened

he was in class sneaking glances at his phone when he gets a chat message from zen that you suddenly collapsed and had to go to the hospital

boy didn’t even give an excuse to the teacher, just grabbed his stuff and ran out

there was only one big hospital in the area, so he basically sprinted there

he’s almost in tears by the time he reaches the front desk, asking where your room was

they say you’re still being treated, so he has to wait for the all-clear

he stays nearby so they can notify him and calls zen demanding to know what happened

zen didn’t even know what yoosung was saying for the first few seconds cause there were too many questions overlapping

all yoosung could get out of the conversation was that you’d collapsed with stomach pain while walking with zen to the store and zen called the ambulance

halfway through, he hears his name and hangs up on zen without a word sorry not sorry

he gets to your bed, sees you still unconscious, and bursts into tears

“is she dying?! is she dying?!!”

“please calm down, it was a rather severe stomach infection, but the antibiotics will–”

“does she need a new stomach?! TAKE MINE”

“sir, there is no need for that, she will be fine”

literally glued by your bedside until you wake up

he’s so worried as to what happened, although you weren’t quite sure either

the doctors explain and give a list of the medication you need to take to ensure full recovery and other precautions

for a second, yoosung forgets he’s a broke-ass college student and says he’ll buy all the medicine necessary

he’s dead serious too, this boy is ready to starve for the next few months

it’s okay though, cause jumin immediately foots the bill when he hears about the situation

surprisingly, he’s extremely dedicated to your recovery, even setting alarms to remind you when you need to take what medication

if you’re even in the slightest bit of pain, he’ll run over and do whatever he can to make you feel better

Zen

like yoosung, he wasn’t there when it happened

he was at practice when he gets a call from the hospital

at first he thought they were calling for a follow-up on his ankle 

but turns out it’s worse news

he only offers a brief apology to the director and other members before running like hell to the hospital

he storms in sweating like a madman, asking the nurse for your information

she recognizes him and starts to fangirl, and he’s this close to yelling cause although he appreciates attention, this was not the time

thankfully, she noticed the urgent tone in his voice and quickly told him you were still getting hooked up to the antibiotics for a stomach infection

he has no idea what that means, but lets her talk and asks when he can see you

she has him wait nearby and calls him over when the doctor tending to you steps out

at this point he’s practically begging them to let him see you and they finally allow it

he runs straight for your hand, grabbing it and kissing it

you’re still asleep, so he tries again to ask what exactly happened to you

they say it was a rather sudden stomach infection, but as long as you take the proper medicine and precautions, you should be fine

he asks them to supply the medicine as soon as possible, and asks for the precautions

he barely sleeps cause he’s too busy watching for when you were gonna wake up

when you do, he almost screams with joy

“babe, you scared the hell out of me!”

he takes time from work to dote on you at home while you recover

he’s almost like a mom… an extremely spoiling mom

Jaehee

it was only by luck that she was there right when you collapsed

she stopped by home for a brief moment during her lunch break

you two were chit-chatting it up when you suddenly cried out and fell

for a few seconds, she was frozen cause wtf just happened

but her body immediately moved to dial the ambulance while crouching to the ground next to you

she followed the operator’s instructions to the T

she almost couldn’t believe how calm she was acting, considering how much of a mess her emotions were at the moment

extremely quiet the whole ride to the hospital

literally a silent ball of stress and anxiety

jumin calls while she’s in the waiting room asking why she hasn’t returned yet

she explains briefly, but she must’ve sounded panicked since he tells her to take the rest of the day off and stay by you

the whole time, she sits on the bench staring at her clenched fists on her lap

just silently running through everything in her head - what caused it? was this a precursor for a more serious illness? has this happened before? what symptoms did you show again?

when they finally lead her to your bedside, she gets all the information she can from the doctors

seriously, if another staff member stepped into the room, they would’ve thought the doctors were getting interrogated by her

when she’s finally satisfied and they leave, she watches you sleeping for a few seconds before stepping outside

she returns minutes later with some of the food she remembered the doctors saying you were cleared to eat for now

and then she sits and waits

only when you wake up does she finally crack a relieved smile, immediately offering you some of the food and drink she bought

she’s incredibly efficient and skillful at helping you recover

doesn’t even need a list to remember what you need and don’t need

Jumin

he’s in a meeting when jaehee receives the news from the hospital

she doesn’t know if she should interrupt the meeting, but knows better than to keep such an urgent thing from him because of a conference

he goes rigid when she whispers the news, curtly saying “assistant kang, i leave the rest to you” before excusing himself 

he demands driver kim to go as fast as possible to the hospital

when he gets straight to the point and asks for your room

the second he hears a room number, he sets off and lets his bodyguards handle the rest

the doctors hurry to answer his questions once they realize who they’re talking to

and the nurses scramble over themselves to make sure they’re doing everything right

he keeps a doctor on standby the whole time until they confirm everything is fine and you’re in the clear

only then does he send everyone out and sit with you until you wake up

when you finally do, the first thing he asks is if you’re feeling fine

he sounds pretty neutral, but you know him well enough by now to know that he’s worried af

you assure him that you feel tons better now, and you watch the tension slightly leave his shoulders

he calls for the doctors again and asks when you’re allowed to go home

they give him the necessary prescriptions and recovery methods and tell him you should be good to discharge by tomorrow

he takes some more time off work to take care of you sorry jaehee

lowkey sort of likes tending to you, he finds it calming

707

you collapsed in the bedroom, so he didn’t notice at first since there wasn’t a camera installed there

he only realized when he saw paramedics storming down your hallway

he almost had a heart attack and was out the door before he realized

uses his laptop to track down which ambulance was dispatched to your address and find the hospital

he drove so fast he actually got there before the ambulance

the staff had to fight to hold him back from following you into the ER

they finally calm him down a bit by taking the time to explain what was happening, yet even then he was a panicking mess

after a tense moment, he agrees to sit down and wait for further news

he gives it a 15 minutes before he whips out his laptop and starts hacking into the hospital database to see if they filed a report on your condition

sure enough, he finds one and starts researching the shit out of their diagnosis

he’s so busy hacking that he doesn’t even notice the doctor calling for him

“excuse me, were you the one waiting for–is that our internal database?”

he slams that laptop shut so fast “nope, school project”

“….. we’ve finished the emergency treatments and supplied her with the necessary antibiotics”

“can i see her?”

when he first walks into the room, he’s sorta just stunned and horrified to see you hooked up to all those IVs

he pulls up a chair and grabs your hand with both of his

literally holding your hand 24/7, almost like he’s scared that something will go wrong if he lets go

you wake up with him napping next to you, his hands still loosely holding yours

when you call his name, his head whips up so fast you thought it was going to fly off

he smiles so brightly when he sees you awake though, even gets teary

uses his enormous secret agent salary to cover all the necessary fees for medicine 

he has you stay with him for a while to recover so that he can watch you better

if he has to work, he brings his laptop into bed so he can be near you

he also sends you tons of memes to cheer you up when you’re feeling icky