#creatinine blood test

[harmeet-saggi]

Understanding Creatinine Blood Test

A creatinine blood test is a test that measures the level of creatinine in your blood. Creatinine is a waste product that is produced by your muscles and filtered out by your kidneys. If your kidneys are not functioning properly, the level of creatinine in your blood will increase.

[recliffelabs]

Creatinine test is a simple blood test that measures the level of creatinine in the blood. This test is often used to evaluate kidney function and to monitor people with kidney disease. Gurgaon, a city in Haryana, India, has several healthcare facilities that offer creatinine testing services in Gurgaon. 

Visit us:- redcliffelabs.com/gurugram/tests/creatinine-test

[transgendz]

My roommates nurse practitioner called me to lmk that his labs on Tuesday were supposed to have a whole additional blood panel that they forgot to put on the order. He needs to go back for labs this week. I am already stressed like hell over rent. Could we please get $50 to cover this? We don't even have the gas money rn. Dm for proof or details and check out my art blog to commission me @theartistrans

PP--$C--V--kofi

[shalvis]

I’m having ocd about my organs and nothing is helpinggggggggggg yaaaaaay

[drforambhuta]

The Significance of Comprehensive Health Checkups in Peritoneal Dialysis:

Regular full-body health evaluations are essential for maximizing outcomes and improving long-term survival among individuals undergoing peritoneal dialysis (PD). These assessments encompass a range of diagnostic techniques aimed at evaluating various health aspects, including kidney function, cardiovascular health, nutritional status, and metabolic indicators. Key elements of these evaluations for PD patients include:

1. Kidney Function Assessment: Routine monitoring of parameters such as serum creatinine, blood urea nitrogen (BUN), and estimated glomerular filtration rate (eGFR) aids in the early detection of declining kidney function. This information guides decisions on dialysis adequacy and modality selection.

2. Cardiovascular Screening: Thorough cardiovascular evaluations, including electrocardiography (ECG), echocardiography, and cardiac biomarker tests, provide insights into cardiac health and function. Early identification and management of cardiovascular risk factors like hypertension, dyslipidemia, and coronary artery disease are crucial for preventing cardiovascular complications and improving survival rates among PD patients.

3. Nutritional Status Assessment: Monitoring nutritional status through biochemical markers (e.g., serum albumin, prealbumin, and total protein), anthropometric measurements, and dietary assessments helps in early detection of malnutrition. This information guides interventions aimed at optimizing protein-energy status and preserving lean body mass in PD patients.

4. Metabolic Evaluation: Assessing metabolic parameters such as serum electrolytes, glucose, lipid profile, and markers of mineral and bone metabolism (e.g., calcium, phosphorus, and parathyroid hormone) assists in detecting and managing metabolic imbalances common in PD patients. Optimizing these parameters is crucial for reducing the risk of metabolic bone disease, cardiovascular calcification, and other metabolic complications associated with end-stage renal disease (ESRD).

There are several good hospitals in India that offer health checkup packages to choose from based on an individual's health status and requirements. A regular full body health checkup helps in increasing the survival rate of patients undergoing peritoneal dialysis.

[lexingtonrenalcare]

Lexington Renal Care

Provides comprehensive care for patients who are facing kidney disease, kidney transplant hospital in Lexington, KY transplants, dialysis, and hypertension.   Our patients are our highest priority. We understand that each the patient is unique and individual needs will be considered when deciding on treatment options.

[drsahinkesikminare]

KREATİNİN YÜKSEKLİĞİNE NE NEDEN OLUR? WHAT CAUSES CREATININ LEVEL

Kanda kreatininin normalden yüksek olması durumunda: Organ ve kas etlerinden, süt ürünleri, kırmızı et, mide koruyucularından, yüksek protein diyetlerinden, susuzluk ve kas erimesinden kaçınılmalıdır. Karaciğer sağlığının bozulması, kas çalışmaları, sakinleştirici ilaçlar kreatininini yüksek gösterebilir. Bitkisel proteinler, bol lifli gıdalar; yeşil çay, biberiye çayı, ısırgan otu,…

[covid-safer-hotties]

Long COVID continues to evade diagnosis through lab tests - Published Aug 12, 2024

NEW YORK, Aug. 12 (UPI) -- Blood and urine tests are ineffective for diagnosing long COVID -- a constellation of long-term symptoms such as chronic pain, brain fog, shortness of breath and intense fatigue, a new study shows.

Without a clear tool to detect and treat the lingering illness, it remains "a major public health burden," researchers noted, affecting millions of people worldwide and significantly altering quality of life.

The new study, funded by the National Institutes of Health Researching COVID to Enhance Recovery (RECOVER) Initiative, was published Monday in Annals of Internal Medicine.

Because few large studies looked at standardized laboratory tests as a way to help diagnose long COVID, researchers decided to examine results of 25 measurements in more of than 10,000 adults enrolled in the RECOVER trial. Launched in 2021, this trial received $1.15 billion in congressional funding. At the outset, participants underwent blood tests and were deemed eligible whether or not they had a previous infection of SARS-CoV-2.

Researchers followed them with surveys every three months and laboratory samples at six, 12, 24, 36 and 48 months after infection or the date of a negative test result.

In comparing responses to questionnaires and routine test outcomes, researchers assessed whether SARS-CoV-2 resulted in repeated laboratory abnormalities regardless if participants had symptoms.

The findings basically revealed little, said the study's lead author, Dr. Kristine Erlandson, a professor of medicine and epidemiology at the University of Colorado Anschutz Medical Campus in Aurora. That's because the laboratory results were inconclusive.

However, she and co-researchers recommended in their study report that clinicians still perform routine clinical tests to rule out other treatable causes of the symptoms in post-acute sequelae of COVID-19, the scientific name for long COVID.

Researchers also uncovered evidence to bolster the notion that SARS-CoV-2 could contribute to the risk of diabetes independent of long COVID -- a link found early in the pandemic.

Individuals with prior SARS-CoV-2 also had higher urine albumin to creatinine ratio. This indicator of early kidney disease has shown an association with cardiovascular conditions in other populations.

Continuing inflammation may be a possible explanation for smell and taste disruptions and post-acute sequelae of COVID-19, researchers said.

"The diversity of symptoms may be one of the reasons that we have difficulty in truly understanding why some people develop long COVID and ultimately how we can treat it," Erlandson said.

"Long COVID is a condition currently defined by symptoms and physical exam findings, not by abnormal routine laboratory measures," she added.

"Similarly, providers should certainly not dismiss a diagnosis of long COVID based on normal clinical laboratory values."

In an accompanying editorial, researchers from Johns Hopkins University School of Medicine in Baltimore noted that most significant unsolved enigmas of the COVID-19 pandemic pertain to the knowledge, diagnosis and treatment of long COVID.

"When [it is] severe, long COVID can be disabling, resulting in job loss or inconsistent ability to perform other roles, such as caregiving. Even in 2024, long COVID remains common," Drs. Paul Auwaerter and Annukka Antar wrote in the editorial.

"Approximately 1 in 20 U.S. adults reported persisting symptoms after COVID-19 in June 2024, with 1.4% reporting significant limitations The incidence of long COVID is 3.5% among immunized people in the Omicron era, and it can occur after reinfection."

The editorial's writers added that "importantly, acknowledging symptoms with empathy and creating a symptom management plan provides a basis for trust and hope amidst uncertainty."

Read the rest of the report at either link!

[miraclesnail]

kronus AU, title still pending

chapter 6, 7

First chapter, previous chapter, next chapter

6 WILL

Will has this super cool, super handy, innate ability to tell when someone is about to pass out, especially if it’s from overexertion. Especially if it’s overexertion from using one’s power. He has a lot of experience with it actually. From newbies discovering their parentage to his friends having to do whatever it takes to survive in the thick of battle to his boyfriend Nico di Angelo shadow-traveling every single chance he gets. 

See, it’s like this. 

The body throws out so many warning signals that Will picks up somehow, kinda like a signal tower. And Travis? Literally blaring them out like a fire siren.

Blood pressure dropping. Heart rate increasing. Body core temperature rising. Increase in C-reactive proteins. Inflammation around the throat and the brain. Muscle tissue breaking down. Creatinine kinase, myosin, and myoglobin levels rising. Nausea, dizziness, developing fever, chills, more to boot. This guy isn’t doing too hot. And entirely unrelated, a random beep of info that his Will-signal-tower picked up, there is severe lack of iron and vitamin B12 reserves. Which…is weird. Those take months to years sometimes to deplete and last time he remembered, Travis didn’t have any disorders that would impair absorption of either those substances or severe bleeding that would lead to iron deficiency. Maybe he’s getting the signals from someone else. 

Nico sometimes calls him a living, walking, non-invasive analyzer with all these lab results that just pop up in his mind. Not that he replaces an actual half a million dollar analyzer that spit out an actual number. He can’t produce anything specific like that, just a general sensation of the enzyme or protein, whatever it is, rising or falling. Wouldn’t that be a dream though? He can save his patients hundreds of dollars worth of lab tests if he can just poof a number into his mind. 

In short — ignoring how he wishes he was more, how he wishes he was better, how he always falls short of actually being useful — Will knows when someone is about to pass out.

And Travis, this weird-Travis, maybe a spy Travis, maybe not even Travis, this god-stabbing guy in front of him? Will gives him a minute or so before he’s out. 

“You should lie down,” Will says in between Clarisse's incensed yelling and Annabeth’s exasperated questioning, eyeing the side-table Travis is dangerously close to. That’s definitely a hazard when Travis faints. “Like, on your side or back. And you should do it now.” 

As expected, Travis ignores him like he did with everyone else, continuing to stare at the ceiling in silence as he digs a hand through his side pockets. 

Well, Will can’t say he didn’t try. 

As long as Travis stays right there, sitting against the wall, then he should be safe from banging his head against—

And of course, Travis stands right then and there, doing the exact opposite of what Will asks. The idiot nearly falls over too, but he stabilizes himself with a hand against the wall and another hand on his knee. And you know what? Will should have expected this. The Travis he knows can’t sit still for long and his ability to follow directions? Just as bad as Nico’s. 

What’s even worse? 

Travis is hobbling his way over to the table where they took out all his sharpened blades and they’re still frozen. Calypso is maybe capable of moving two or three inches forward and Nico an inch, but the rest of them? They’re as still as a rock. Even Connor, Travis’s match in every way, is just as immobile and confused and lost as the rest of them. Maybe it’s time to panic. Maybe it’s time for someone to do something before they get a knife in the gut. 

“Hey Travis,” Piper tries to charmspeak again, her lovely voice not showing even a hint of unease. “Why don’t you just stay right there. You’re tired, aren’t you? Sit.”

It didn’t work. It didn’t even stall Travis that much. Maybe just the tiniest hint of a pause, but it’s not enough. Travis makes it to the weapon table and grabs — a generic orange pill bottle? Will wracks his brain for what’s inside. He wasn’t the one to unload everything, more occupied with making sure Clarisse is fully healed, but it’s just a regular bottle, isn’t it? 

“That’s enough, right?” Travis says, voice faint and just barely above a whisper, eyes clenching shut as a hand goes to rub his throat over the turtleneck. “Then, I’m going—”

Travis’s consciousness leaves him. Will feels it go and this is the absolute worst place for Travis to pass out over! But before the son of Hermes can fall over the table of sharp pointy weapons, a hand slams down on the table’s edge, definitely conscious again. 

Huh. 

Guess Travis did not pass out. Will wonders if his lack of sleep and exhaustion is catching up to him because now he’s now smelling ozone. 

Oh hey, he can move. 

Ever the opportunist, Annabeth springs forward to snatch the phone back, but Travis all but tosses it to her. Annabeth fumbles with the phone, almost dropping it.

“Wait for their call,” is all Travis says, teeth gritted, nails digging into his neck, before popping open the pill bottle and dumping out four non-descript, oval pills into the palm of his hand. 

Warning bells fire through Will’s head as his god-gifted, everything-medical textbook tells him what it is without needing to test it. 

Cyanide. 

But there’s no way that Travis is going to—

In one swift motion Travis gulps it all down, swallowing and clamming both hands over his nose and mouth. 

7 I should try out for the Olympics

Not to flex or anything, but Travis is so good at running. 

Not only is he running in the dark, he’s running from a levitating, man-eating, manic zombie in a war-torn, rubble-strewn terrain while he himself is screaming on the top of his lungs and not once taking a single breather. 

“I can’t see where I'm going. Oh gods I don’t know where I’m going. Stop following me. Leave me alone! Why are you trying to eat me? I thought we were friends! I am telling your mom about this, Lou!” 

Like that’ll do anything. He doesn’t know Hecate. He never met Hecate. He was hoping just the threat alone would be enough to snap Lou Ellen out of whatever haze she’s in, but nope. No such luck. 

He doesn’t know if it’s all skill or all luck or part skill and part luck but he is keeping a good distance between him and Lou. He’s surviving! He is surviving! 

He hears the arrow whistling first before it snags him exactly at the heel of his sneakers and he’s tripping face first into the floor. 

Travis admits his memory of his long since dead co-counselor (and now recently proclaimed ex-friend) is a bit effy but was Michael always this pin-point accurate? He was literally speeding around like Sonic himself in this pitch darkness!

Travis hisses when his hands grind against something sharp and pointy in his attempt to cushion his fall. He’s sure he’s bleeding and in severe need of a tetanus shot. But Lou Ellen is seconds behind him and there's no time to waste. He picks himself up and keeps running.

The problem is where to run to because he has zero idea where he's going. 

So far he’s retracing the path he took when he ran from Weird-Connor because he knows for sure there is no dead end but he’s about to hit the area where he popped into this dystopia and then after that? What then? Fight? Pray? Talk it out? Cry and then pray?

“You know what? I’ll get there when I get there!” Travis settles on, hurdling over a toppled folder cabinet. 

Lou Ellen hasn’t tried that gravity defying magic trick of hers yet. Zero ideas why, but Travis is grateful for it. 

Just in case though he snags some stuff off the desks of the abandoned office. Some pens. A couple paper clips. A bulky stapler which he hurls at Lou Ellen. It lands squarely on her forehead but there isn’t even a single flinch or misstep as she continues to half-limp, half-jog after him. 

Which brings him to his next problem, how can a zombie with one busted leg move so fast?!

And how can zombies run? 

Aren’t they supposed to be shambling hunks of meat barely kept together by ligaments and tendons with zero regeneration abilities whatsoever? 

“Stop running!” Lou Ellen yells in a very clear, very unmistakable way. 

And what kind of zombie can talk?!

“No! You go away! Leave me alone!” he yells back. 

“But we’re friends! How can you talk to your friend this way?”

“Friends don’t try to eat each other!”

“Come on. You’re being a bit dramatic. A little bite here and there never hurts anybody.”

An arrow snags the flaps of his khakis and pins him to a toppled swivel chair. 

“Screw you, Michael,” Travis shouts, desperately pulling the arrow by the shaft to dislodge it. “You and your cabin are going to have the worst summer of your life! I’m doubling down—No! I'm tripling down on the amount of pranks I have in store this summer! This will be the worst summer of your and your cabin’s life!”

He manages to pull the arrow out but the few seconds wasted is enough for Lou Ellen to catch up to him. She tackles him, knocks him onto his back, and straddles him by the waist. 

Up close her smile is no less deranged. 

“Can we be friends who respect each other's boundaries by maintaining a six feet physical distance?” he suggests quickly, tackling on a shaky grin.

And in response, Lou Ellen opens her mouth and leans down. 

Travis panics, slamming the heel of his hand hard against the underside of her jaw. Bones definitely crunch underneath his palm and Travis winces with guilt. With all his strength and demigod adrenaline backing him up, he unbalances Lou Ellen and flips their position. He breaks the arrow into two and stabs the jagged ends deep in the eyes. 

“I’m sorry,” he says. “I’m really sorry.” 

Then Travis stands and starts running again. 

He doesn’t really get far. 

Probably only ten feet before a trap snare snags his ankle and Travis is flying to the ceiling, dangling 20 feet from the ceiling. He’s disoriented, vision spinning as he blinks hard to get his bearings stable. 

“Whyyyyy,” Travis groans, grunting in effort to reach the rope tied to his ankle. But every attempt to reach up results in him flopping back down and swinging more than ever. And every swing he does? The ropes dig more and more into his flesh. His ankle is supporting his entire weight and crap does it hurt. 

“You haven’t fallen for that in years,” Michael comments perched in an open air duct like a Hawkeye wannabe, one leg up and pressed against his cheek and one leg swinging freely. 

“You know, I really hate your guys right now, Mike,” Travis says as he swings back and forward upside down, glaring the best he could. He hopes it looks threatening. Annabeth told him he looks like an angry kitten when glaring. 

Michael stares for a moment before snorting with a silver of fondness. “You look like a child when you do that.”

Fondness. So Michael doesn’t hate his gut entirely. Travis can use that. 

“Come on, Michael,” Travis pleads again. He has been doing a lot of pleading today actually, “Aren't we friends? I’m Will’s 4rd, maybe 5th BFF outside of his siblings and boyfriend. Once he knows how you treated me, you are in sooo much trouble.”

At Will and at siblings, Travis knew he screwed up his chance. Michael’s eyes harden in regret and grief before turning away. He breathes in deeply, hands squeezing his crossbow tighter.

“I’m sorry, Travis. I’m not sure what’s going on with you. But I can’t let this opportunity pass.” Michael glances down at Lou Ellen, one eyeball free now, grinning up at them. “If it's any comfort, I’ve seen Lou Ellen kill before and she’s relatively fast. The pain should last for a few minutes tops.” 

“I don’t want to die, Michael,” Travis tries again. Don’t mention Will. Don’t mention Kayla or Austin, he chants to himself. “There’s so much I haven’t done yet. I haven’t told Connor the wonders of college and how much it sucks and how everyone in Rome University all have sticks in their butts. I haven’t… I haven’t… Okay, I don’t have many goals but that doesn’t mean I don’t want to live and make some goals!”

Michael turns away. “I’m sorry, Travis.”

Travis looks down at Lou Ellen, now arrow free, and levitating up to him. Is she drooling? Oh gods she is. Travis wiggles harder than ever to no avail. The rope is tight against his ankle and unrelenting. 

He doesn’t really want to use any of his abilities with people around but it looks like he might have to if he wants to survive. Maybe if he distracts Michael and blind Lou Ellen again … but he needs an opening to do that and all he has are the pens and paper clips he stole. 

Are you seriously going to let yourself die because you don’t want people watching you fight? A little incredulous voice that sounds a lot like Annabeth and Will and Connor sighs at him. Get it together. 

Travis hooks his finger over his bracelet, a hand-woven gift from years ago. But before he could pull it free, a girl’s voice, deeper than Lou Ellen, bellows from below him, “Hey! Enough, Lou! Get away from him.” 

Travis throws his head back to see who but he hears Michael cussing first. 

An arrow whistles above. 

The rope snaps.

“Ah, shoot,” the girl says. 

And he’s falling head first 20 feet to the ground. 

He read somewhere a fall from that height, head first, is death or complete, utter paralysis. Okay, maybe not read. Maybe told. Maybe lectured. From Will and Annabeth after a prank gone wrong and he nearly ended his life. Either way he’s falling and about to land head first. 

Travis flails desperately to right himself, to at the very least land feet first or knees first. But it's not working and he braces himself for impact. He crashes and bounces, not on the hard tile like he expected, but someone more soft and squishy. Mushy even. And … wet? With this distinct smell of decay too. 

Travis opens his eyes and tries to get to his feet but his fingers are sinking into what he is now recognizing as someone’s eyeballs and he pulls away screaming. 

Is this just penance for that time he pranked Malcolm 7 years ago with the fake Goliath Birdeater spider? He paid for that already!! After stopping Malcolm from nearly burning down his cabin, and after Annabeth restrained Malcolm from murdering him and his brother, Travis had the worst time of his life that year in training. 

Malcolm? Absolutely terrifying when angry. Would not recommend pissing off. 0/10. 

Not that it stopped Travis from pulling a similar prank with cockroaches dangling over the doorway. 

“Sh! You’re being too loud!”

“Well, excuse me but I just grabbed a handful of someone’s eye—” the rant dies on his lips when he feels a hand grab a chunk of his shirt from behind. 

And suddenly, he’s being lifted.

The dirty tiles are disappearing. 

The dim lights are gone. 

He’s being carried. He’s flying. He’s soaring. He’s falling. He’s crashing into the ground. He faceplants into the tile at rocket speed and slides shoulder first into a solid wall. 

“Oh my gods, why do you feel 100 pounds heavier?”

Normally Travis would jest back, but everything he ate is coming back up … which was nothing except for that banana and apple but it still feels like shit coming up. And he feels like shit now. His vision is spinning. The world is upside down. The world is whirling at max speed. The world is out to get him because this is not his freaking day.

He feels a hand patting the back of his shirt and weakly Travis tries to wave them away. He must look so pathetic. 

“Hey, are you okay?”

He waits to make sure nothing is going to come out before attempting to stand. The last thing he wants to do is to vomit on the girl who saved him.  He wobbles for a bit, the girl supporting him with a hand on his upper arm. But once he’s sure he isn’t going to throw up and isn’t going to fall back on his butt, he turns to face her. A whole speech was on his lips — something about saving him from becoming dinner or something — but it dies when he looks at the girl and how familiar she is. 

Black hair that ends at the shoulder, with bangs that barely just graze the top of her eyebrows. Black eyes with high cheekbones and an aristocratic curved nose. Pale, almost ghostly face.

Just style the hair differently and this girl could be mistaken for Nico. 

A really long time ago, before they found Chris in the labyrinth, before Nico even left the camp the first time, when Nico actually stayed with them for a couple weeks as a happy, clueless 10-year-old, he saw her a couple times, hanging out with the Hunter of Artemis. No… as an actual Hunter of Artemis. They gave someone in their group something. A shirt spiked with centaur blood. Phoebe, if he remembers, so Percy could go. This girl went with Percy and never came back. Nico ran away from them because she died. Nico’s older sister. Nico’s dead older sister. 

“Travis? You have to talk to me. Are you okay?” Bianca di Angelo says, alive and breathing and well, eyes squinting as she tiptoes closer, her crown just barely passing his chin. 

Travis may have, may not have gawked at Bianca for a minute or two. 

Like… Bianca is supposed to be dead. Dead! She died! Almost four or five years ago! And she chose to be reborn! So how, why is she still here? 

Bianca snaps her fingers in front of his face and he flinches from the sudden sound. 

“Hey! What was that for?” He steps back, but two hands stop him by the arms. Two very rotten hands attached to two very dead people with falling hair and sunken cheeks and one eye between the two of them. But they hold him with remarkable strength for two dead guys. 

Bianca unsheathes a knife with grace and fluidity that must have come with tons of practice. None of that awkward, hesitant inexperience he remembers her having. He appreciates it for a second before dissolving into frantic struggling.

A knife is used for many things but never ever for a friendly greeting. At least in his humble opinion, knives are never used for a friendly greeting. Who knows. Maybe the Big Three children do things differently. 

Bianca strides up to him with her knife in hand. Despite looking like a skeleton with her twigly arms and legs and her pale, bony face, she is terrifying. There’s this air of a commandeering presence, of authority, of ‘you-mess-with-me-and-off-goes-your-legs’ aura. 

She stops before him, a hand raising, and Travis flinches, closing his eyes and bracing himself. He feels fingers on his neck, feather light, lightly tugging the collar of his shirt down. Travis opens his eyes tentatively to find Nico’s sister frowning. 

“You can’t be Travis,” Bianca says.

“What? Y-yes I am!” he squeaks, but Bianca is not convinced. She nods at her two henchmen to hold him tighter, the grip almost painful. A palm rests on his forehead and Travis, with his admittedly very limited knowledge about children of Hades’s powers (Hey! Nico is a secretive person and Travis isn’t dumb enough to get on Nico’s bad side right now but maybe one day…when Nico is more chill, maybe he’ll try his luck), stills in terror. He pictures a skeleton bursting from his skull, maggots running down his eyes, his whole body disintegrating into dust. But Bianca frowns some more and pulls her hand back. She pats him down, reaching into his empty pockets, pulling out his beaded necklace out under his shirt with a blank stare, completely glossing his weapon ike they all do, and then going lower to his shoes before traveling back up to his waists, frowning more and more. 

“You’re not dead,” she mutters. 

“I am very much alive,” he agrees with her.

“Your wounds are gone.”

“Ambrosia pulls all sorts of miracles,” he lies. 

Bianca stares at him, wide-eyed. “You found ambrosia?! Really? That’s awesome!”

And holy cow. That is the stare of someone who believes him entirely. Normally, not a single person takes him seriously. Is this guilt he’s feeling? Why does he feel like a shit person?

“Sorry. I was fibbing.” 

“Oh.”

Travis wishes he could sink to the ground as Bianca’s hope wilts and burns but the two skeletons hold him up. 

Bianca steps closer to stare at him with curiosity. He can really see the similarities she has with Nico. The high, royal cheekbones. The pale, almost sickly white of their skin. Black hair as dark as Hades’ soul. The intimidating gleam of their cold eyes. The dimples when they smile— wait, smile. Bianca is smiling. Nico doesn’t do that at all. He has been doing it more and more ever since he started hanging with Will but still not really enough. 

“Oh well. You’re alive and not hurt. That’s all I care about. I saw you fell into that trap by the way,” she says with a grin, almost teasing-like if Travis looks into it enough. “I’m never going to let you live that down.”

Then Bianca whips to the right and Travis finally notices the second person standing there, obscure in the dark not helped at all by the black attire they’re wearing.

“Hey—” Lightning flashes, illuminating everything for just a second. “—Silena, you missed it. Travis—”

He’s not sure if it’s the following thunder or the blood roaring in his ears but he didn’t catch the rest of Bianca’s words. 

Silena Bearuguard, another friend who should be dead dead dead, stands there with something pressed to ear.

“What…” the girl with Silena’s face whispers in Silena’s voice and in a very Silena-like way, tucks a strand of her black hair behind her ears that immediately comes undone. It draws his eyes to the long scar running alongside her cheek horizontally and ends at her ear. 

“S… Silena?” he croaks, not wanting to believe it's her but it's definitely her. Just with shorter hair and scars where there shouldn’t be scars. 

Silena stares at him the same way Bianca and Michael did, eyes going to his shirt first and neck second. She grows rigid. Her hands shake. He hears voices coming from the thing pressed against her ear. A phone. People. Screaming. Silena flinches, bringing the phone a bit away. 

And Travis hears it. 

Connor’s on the other line and he’s screaming for help. 

Her eyes come back to him and they’re anything but calm. But the way the words flow and come out so strong and solid, Travis wouldn’t have guessed nothing else but calm. 

“Sleep, Travis. Sleep.” 

He doesn’t even remember hitting the ground. 

xxxxx

Someone pulls his hands away from his mouth and nose. He opens his eyes to make sure. Not his own hand. But someone else's. 

No. Wait, stop, you don’t understand.

Someone rubs his back. 

Wait, don’t help me. Not when he’s awake too. 

Someone is speaking. Will’s voice. A hymn. 

No, wait. 

And he’s vomiting, all the pills he just swallowed in a small pile of mucus and bile. 

“Travis? Travis, hey buddy. It's going to be alright. Let’s just talk it out. There’s no need to do that. Come on, here.”

He smells it before he sees it. Brownies from his favorite bakery back home. Nectar. In Will’s hand. Just enough for a sip, just enough to not feel like shit but not enough to heal. His mouth waters. His hand is snapping forward to grab the drink and he slaps it away before he could raise it to his lips. The plastic bottle bounces once, twice on the hardwood, gold droplets scattering across the polished floor.

He told him he got this. He said not to worry about it. He can’t fail. He absolutely cannot fail. 

His head snaps up to find Piper, far away, behind two other demigods, all staring at him. 

“Piper. Piper, you have to—” his vision blackens as he hears a distant laugh. A wall of fire that’s circling him. He can see Piper’s face over the walls of flames, horrified. He can hear Leo’s voice, yelling at Piper to let him go. More yelling. More screaming. The fire spreads faster and closer. Until it’s at his feet and ankles and crawling up his army pants to his thigh and torso. It’s just a memory but he still remembers. The overwhelming pain. The excruciating heat. That terrifying lack of freedom to move. 

He digs his nails into his neck until the memories fade away. There’s no fire. He’s not there anymore. He’s not burning in that circle. There’s no pain. Everything’s okay.  

“Piper, charmspeak,” he grits out, pushing down more memories that want to surface, “Put me to sleep just like that first time. But twice. Say it two times.”

Piper shakes her head in confusion. “I… what was that?” 

“There’s no time to explain. Just do it please.” That sounds too much like a plea, too much like how he pleaded back then. He could feel more memory itching forward but he pushes it down just like the rest. 

“That was… me and Leo… but I don’t remember… when did that…”

“Piper, just—”

But he can see she’s not going to react in time, still hung up on that memory. The laughter, the roaring is getting louder and louder. Any minute now and he won’t have full control anymore. 

Another charmspeaker then. But Piper is the only one he sees. No Drew or Silena. 

Swallow the pills again? But Will will just make him barf it back up again. 

His eyes snap up, and spots the phone in Connor’s hand for some reason, not Annabeth’s. He knows Bianca doesn’t want him to call, wanting to pull some theatrical rescue. But Silena is his only option. 

Just… why did it have to be in Connor’s hands?

If he runs from me, it’s over. So full speed. 

He launches himself forward at Connor. And overshoots too far to the right by about a foot. A year and a half in this body and he still can’t get used to the bursts of speed he’s capable of now. He whips around back to Connor who squeaks and backs away, tripping over his own two feet and falling flat on his back, displaying not a single ounce of that usual gracefulness he has come to know. If he had time, maybe he would stop to question it but the phone is loose in Connor’s hand. It’s never going to be easier than this. 

He swears he was aiming for the phone. 

But his hand wraps itself around Connor’s neck instead. 

He panics, leaning down and biting his bicep enough to taste blood. He isn’t sure if it’s himself, or if the pain really did make his grip loosen, but Connor wiggles free from under him. 

His head pounds and screams in protest. There’s a mumble jumble of indecipherable garbage bouncing around in his mind. His left arm is completely out of his control and he can feel his left leg about to go too. There’s no time to wrestle control back. Not with this many people around him, not with all the variables it poses. ***

Silena. He needs Silena. 

He doesn’t remember when but he must have taken the phone while Connor was leaving. His hand is shaking as he unlocks the password and finds her contact in favorites. ***

He doesn’t remember what he said, or when she picked up or why she sounds so confused. 

All he knows is that at the first sleep, he’s out and under. 

[youuuimeanmee]

I LOVE YOO 220 Thoughts

1. What excites me the most on this episode is, we got a glimpse of how Yui abused Nol in the past! (Not that I enjoy seeing Nol being abused, far from it, but I'm glad we finally see the plot moving) This is the discussion back in ep 150:

And with today's episode, we now see how Yui utilizes her power as the owner of the hospital: interfering with the doctors and nurses' decision, having their license revoked if they try to defy her, rewarding them with money -or anything- if they do as she say... Of course Yui's hand would stay clean if everyone is too scared of her! It really give us a glimpse of how she abused Nol in the past. Ugh. Now I wonder, did he also had the nurse he's close with removed from his sight because of Yui? Did she also gaslighted him into thinking it's his fault? 😒

Hearing Yui's argument is laughable actually. When a patient is unconscious, a doctor has the right to do some tests based on medical judgement in order to reach the correct diagnosis for the right treatment, because a sleeping patient can't tell the doctor what's wrong with them afterall. She has no right to veto as a mother too(?), since Kousuke is already an adult. Now, whether the CEO of the hospital has the right to revoke a medical lisence based on personal opinion -- or not, I can't tell because I don't know the laws. But well, money and power goes a long way, sadly.

2. At least Nol wakes up with the person he care by his side. Kousuke wakes up with no one in sight, and the sound of arguments outside. Quimchee just loves hammering down Kousuke's sign of neglection, huh. As much of an asshole Kousuke is, he's still the victim of abuse just like Nol :(

3.

AW NAH BITCH, STAY AWAY FROM JAYCE. STAY AWAY FROM NOL. JUST GO AWAY, NO ONE WANTED YOU HERE.

4. Now, about the reason why Yui is so adamant not letting Kousuke be tested by a literal professional. Many people has guessed it's because Yui doesn't want anyone to find out Kousuke is not Rand's biological son, but I don't think we're there yet. Hansuke mentioned basic tests; as far as I know, the basic, standard tests don't include blood-type test or DNA test. It usually only covered the potentials of:

Irregularity in blood (haemoglobin, platetet, RBC counts)

Infection (WBC, Lymphocyte counts)

Liver disfunction (AST, ALT)

Kidney disfunction (Creatinin, Urea, Bilirubin)

Diabetes (blood sugar)

Cholesterol-based illness (LDL, HDL, triglycerides)

Irregularity in electrolytes (Na, K, Cl, Ca)

And that's the gist of it. There's not much to get, unless Yui doesn't want anyone to find out Kousuke is actually diabetic? Maybe she inserted diabetes medicines inside his food? Kousuke did say they have personal chefs, maybe they also received Yui's order. I kinda doubt it though, this seem like a stretch.

It's a different story if Hansuke wanted to check the possible substance inside Kousuke's body, though. Hansuke suspected Kousuke is under the influence; it's the easiest answer that could explain Kousuke's abnormal behavior.

This is just some wild theory but I suspect Yui inserted some antipsychotic drugs in his drink or food (remember the family chefs?) to keep Kousuke in check. If Hansuke finds out about it, it will reveal that Yui has been hiding the fact that Kousuke has some mental disorder, and that could jeopardize his position as the new CFO; that's why Yui doesn't want a blood work. Just a guess 💀

Btw, this is Shinae on episode 14 LMAO

Oh Shinae. Now this doesn't seem like a joke anymore ☠️

Oh. WAIT.

💀💀💀

5. [Yui: what has you scrambling around in distress?] [Kou: I can't recall... ] [Yui: Aww that's too bad...]

Look at that sinister smile. She is DELIGHTED Kousuke forgets. Since Yui knew he hit his head on the wall, I think it's safe to assume(?) she knows Kousuke was looking at patient record earlier. She knows which name that triggers him. Does it mean she doesn't want Kou to find out about Nessa (further, what she did to her)? Has Yui always used Kou's "ignorance" (memory issue) about Nessa's fate to let him mock Nol about her disappereance?

Nol you couldn't be more right. I look forward to see Kou finding out he has been mocking Nol's mom's absence when it's his own "dear mother" who "killed" her. The devastation...

6. I still don't get why would Yui throw away Rand's gift. If anything, I think it'd benefit her more if she give it to Kousuke. Something like: praising him, how he's done such a good job being a CFO that his father would give him an early expensive present, gaslight him into thinking it's not enough, but just a little more until he'd truly acknowledge him, etc. I thought he'd be easier to manipulate if he get enough reward (which he clearly didn't get)? It feels like Yui's manipulation is getting old. Idk, I thought a goal would be much sweeter if he get to taste it, so he'd work even harder. But so far, he didn't taste any of it.

But then it hit me. If Kousuke sees the real present, he'd know his father does care about him. He won't need Yui anymore, he'd start to rely on Rand, as in, the person. And Yui doesn't want that. She wants Kousuke to be fully in her control, she wants him to keep relying on Rand's image by her words; that Rand is a cold man who doesn't care about his family unless Kousuke surpassed him. She just... never let Kousuke to be free. (Which is why I realized Nol has the potential to be a much scarier manipulator than Yui, but that's another topic for another day).

7. Yui touching Kousuke's injured hand without apologizing is such a psychopath thing to do: lacking of guilt or empathy.

8. BAHAHA since we're almost at the end of the year, it's nice to see the reference of earlier episode!

Though, could this be a foreshadowing? If Shinae really becomes Kousuke's assistant in the future, would she be included in the future hospital inspection? Would she play a role in uncovering Nol and Kousuke's mistreatment in the hospital? Lol.

9. MEG!! AOEBJDDJ I hope she would return the gift to Kousuke, just like Shinae who return the bible to Nol! Kousuke needs to know Rand is more caring than he seemed and Yui is much more wicked than he thought! This is probably Meg's role as the member of the Black Team: to open Kousuke's eyes that he still has people who care for him as who he is.

And that's it! See you next week 👋

[flyonthewallmedstudent]

Psittacosis

Let's open with a case report, like we're on an episode of house.

Case Report

35 yo otherwise well, suddenly presents with 2/52 of high fevers and a headache (usually this means > 39)

a/w chills and rigours, responsive to medication/presumably panadol and intermittent (would resolve then come back)

no respiratory symptoms

She had neutrophilia and intrestingly, a CRP of merely 30.

CXR revealed nonspecific consolidation in 2 lobes, they followed this up with a CT revealing pretty impressive ground glass opacities (or GGOs)

She was empirically treated on IV tazocin only (I'm used to atypical coverage empirically started if there's even a whiff of resp, which she may not have had symptoms but her CXR confirms this)

eventually she was on referred to the authors, who felt her CT findings with consistent with psittacosis and treated her with doxycycline which resolved her symptoms in 48 hrs

on further history, it was revealed that she had parrots at home, one had died 2 days preceding her symptoms and she was sleeping next to its body at night (crazy)

What is it:

psittacosis is a zoonoses (transmitted by animals, animals = reservoirs), in this case, transmitted by birds. Orthinoses if birds in general, but psittacosis if referred to macaws, parrots etc. YOu can also catch it from chickens and turkeys.

Some what related is Bird fancier's lungs. Which just sounds fancy.. I'm sure it's just an old term.

Bird fancier's lung refers to a hypersensitivty pneumonitis (ILD) caused by bird exposure. DIfferent disease process, but birds is the come denominator. INhaled bird particles

Psittacosis specifically refers to the infective disease process caused by a bacteria. It was 'identified" or reported in the 1870s, when a cluster of 7 swiss patients developed the same symptoms and found to have possessed tropical birds.

Similarly, in the 1930s there was an outbreak in the US with a mortality of up to 20% (80% in pregnant women), also attributed to parrots from South America.

Eventually, with further scientific development, the causative pathogen was identified as chlamydia psittaci, an atypical intracellular organism.

Psittacosis is a significant differential to consider in community acquired pneumonia as it has a high mortality if left untreated. But it is rare, and causes about 1% of cases in the US. Part of this is due to improved hygiene practices and strict importation guidelines of tropical birds.

It's spread through the inhalation of dust with either dried faeces or respiratory secretions from infected birds.

Clinical features

Variable! but the key thing on history is birds

incubation time can be anywhere from 2 days to 20

Flu-like (fevers/chills/myalgias/arthralgias/malaise/headache)

high fevers is key

respiratory symptoms - does not always present as per the case report, and can be mild on spectrum (dry cough) to more severe

if systemic, can also get photophobia, deafness and epistaxis

Rare (particularly where doxycycline or azith are prescribed at a low threshold): hepatosplenomegaly (look out for LFTs), GI symptoms (remember CAP can present with diarrhoea, nausea/vomiting --> always do a CXR)

even rarer: endocarditis or myocarditis, encephalitis or hepatitis (usually the complications of untreated disease)

Increased risk groups:

pet shop owners

bird owners

farmers

zoo, lab workers where birds are kept, vets, avian quarantine station workers

poultry handlers/workers

So ask if they live or work with birds, or had recent exposure.

INvestigations

serology is gold standard - so looking for antibodies in blood tests

it's intracellular - so hard to culture if even possible on standard blood cultures

elevated ESR/CRP may see LFT derangement and creatinine rise in systemic illness

CXR- usually lower lobe changes, if CT is done, you can get pulmonary infiltrates with GGOs

Treatment:

usual culprits for atypical coverage: azithromycin 3 days or doxycycline 100 mg BD for 14/7

Differentials

always broad if systemic features only (also consider IE and other causes of sepsis)

with resp symptoms - legionella, Q fever, mycoplasma, tularaemia (except for tularaemia, the rest are also covered by doxycycline)

In clinical practice, I'm so used to just having atypicals on board for any cases of atypical pneumonia. I really take it for granted. But will consider this differential more myself in cases of PUO - but I feel like there should be at least CXR findings regardless.

Anyway, prognosis is very good so long as it is treated.

Sources:

CDC guidelines

Case Report: Importance of Clinical history in Psittacosis

StatPearls

Wiki

[rchivesv]

November 12, 2024

Read namaz

Meditated

Exercised

Classes :

Physiology - resting membrane potential- genesis, factors affecting, Gibbs donnan equation, nernst potential, Goldman-hodgkin-katz equation, contribution of potassium and sodium diffusion potentials and chloride movement.

Anatomy - pectoral region - cutaneous and blood supply, mammary glands, pectoralis major and minor, subclavius, clavipectoral fascia, serratus anterior. Axilla - location, shape, boundaries, contents, brachial plexus, erb's palsy, klumpke's palsy, horner's syndrome

Pectoral region dissection!!!!!

Biochemistry lab - normal urine analysis - urinometer, test for calcium, phosphate, ammonia, urea, uric acid, creatinine

Helped seniors to decorate

Watched fourth episode of house MD and learnt about MRSA - methicillin resistant staphylococcus aureus

[mcatmemoranda]

Rheumatoid Arthritis:

Refer to rheumatologist.

●Nonpharmacologic measures – Nonpharmacologic measures, such as patient education, psychosocial interventions, and physical and occupational therapy, should be used in addition to drug therapy. Other medical interventions that are important in the comprehensive management of RA in all stages of disease include cardiovascular risk reduction and immunizations to decrease the risk of complications of drug therapies.

●Initiation of DMARD therapy soon after RA diagnosis – We suggest that all patients diagnosed with RA be started on disease-modifying antirheumatic drug (DMARD) therapy as soon as possible following diagnosis, rather than using antiinflammatory drugs alone, such as nonsteroidal antiinflammatory drugs (NSAIDs) and glucocorticoids (Grade 2C). Better outcomes are achieved by early compared with delayed intervention with DMARDs.

●Tight control of disease activity – Tight control treatment strategies to "treat to target" are associated with improved radiographic and functional outcomes compared with less aggressive approaches. Such strategies involve reassessment of disease activity on a regularly planned basis with the use of quantitative composite measures and adjustment of treatment regimens to quickly achieve and maintain control of disease activity if targeted treatment goals (remission or low disease activity) have not been achieved. (

●Pretreatment evaluation – Laboratory testing prior to therapy should include a complete blood count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), aminotransferases, blood urea nitrogen, and creatinine. Patients receiving hydroxychloroquine (HCQ) should have a baseline ophthalmologic examination, and most patients who will receive a biologic agent or Janus kinase (JAK) inhibitor should be tested for latent tuberculosis (TB) infection. Screening for hepatitis B and C should be performed in all patients. Some patients may require antiviral treatment prior to initiating DMARD or immunosuppressive therapy, depending upon their level of risk for hepatitis B virus (HBV) reactivation.

●Adjunctive use of antiinflammatory agents – We use antiinflammatory drugs, including NSAIDs and glucocorticoids, as bridging therapies to rapidly achieve control of inflammation until DMARDs are sufficiently effective. Some patients may benefit from longer-term therapy with low doses of glucocorticoids.

●Drug therapy for flares – RA has natural exacerbations (also known as flares) and reductions of continuing disease activity. The severity of the flare and background drug therapy influence the choice of therapies. Patients who require multiple treatment courses with glucocorticoids for recurrent disease flares and whose medication doses have been increased to the maximally tolerated or acceptable level should be treated as patients with sustained disease activity. Such patients require modifications of their baseline drug therapies.

●Monitoring – The monitoring that we perform on a regular basis includes testing that is specific to evaluation of the safety of the drugs being; periodic assessments of disease activity with composite measures; monitoring for extraarticular manifestations of RA, other disease complications, and joint injury; and functional assessment.

●Other factors affecting target and choice of therapy – Other factors in RA management that may influence the target or choice of therapy include the disabilities or functional limitations important to a given patient, progressive joint injury, comorbidities, and the presence of adverse prognostic factors.

Osteoarthritis

General principles – General principles of osteoarthritis (OA) management include providing continuous care that is tailored to the patient according to individual needs, goals, and values and should be patient-centered. Treatment can be optimized by OA and self-management education, establishing treatment goals, and periodic monitoring.

●Monitoring and assessment – The management of OA should include a holistic assessment which considers the global needs of the patient. Patient preferences for certain types of therapies should also be assessed, as compliance and outcomes can be compromised if the care plan does not meet the patient's preferences and beliefs.

●Overview of management – The goals of OA management are to minimize pain, optimize function, and beneficially modify the process of joint damage. The primary aim of clinicians should include targeting modifiable risk factors. Due to the modest effects of the individual treatment options, a combination of therapeutic approaches is commonly used in practice and should prioritize therapies that are safer.

●Nonpharmacologic therapy – Nonpharmacologic interventions are the mainstay of OA management and should be tried first, followed by or in concert with medications to relieve pain when necessary. Nonpharmacologic therapies including weight management and exercises, braces and foot orthoses for patients suitable to these interventions, education, and use of assistive devices when required.

●Pharmacologic therapy – The main medications used in the pharmacologic management of OA include oral and topical nonsteroidal antiinflammatory drugs (NSAIDs). Other options include topical capsaicin,��duloxetine, and intraarticular glucocorticoids. Our general approach to pharmacotherapy is described below.

•In patients with one or a few joints affected, especially knee and/or hand OA, we initiate pharmacotherapy with topical NSAIDs due to their similar efficacy compared with oral NSAIDs and their better safety profile.

•We use oral NSAIDs in patients with inadequate symptom relief with topical NSAIDs, patients with symptomatic OA in multiple joints, and/or patients with hip OA. We use the lowest dose required to control the patient's symptoms on an as-needed basis.

•We use duloxetine for patients with OA in multiple joints and concomitant comorbidities that may contraindicate oral NSAIDs and for patients with knee OA who have not responded satisfactorily to other interventions.

•Topical capsaicin is an option when one or a few joints are involved and other interventions are ineffective or contraindicated; however, its use may be limited by common local side effects.

•We do not routinely use intraarticular glucocorticoid injections due to the short duration of its effects (ie, approximately four weeks).

•We avoid prescribing opioids due to their overall small effects on pain over placebo and potential side effects (eg, nausea, dizziness, drowsiness), especially for long-term use and in the older adult population.

•We do not routinely recommend nutritional supplements such as glucosamine, chondroitin, vitamin D, diacerein, avocado soybean unsaponifiables (ASU), and fish oil due to a lack of clear evidence demonstrating a clinically important benefit from these supplements. Other nutritional supplements of interest that may have small effects on symptoms include curcumin (active ingredient of turmeric) and/or Boswellia serrata, but the data are limited.

●Role of surgery – Surgical treatment is dominated by total joint replacement, which is highly effective in patients with advanced knee and hip OA when conservative therapies have failed to provide adequate pain relief.

●Factors affecting response to therapy – The discordance of radiographic findings to pain supports the notion that the mechanisms of pain are complex and likely multifactorial. The placebo effect is also known to impact response to therapy.

●Prognosis – Although there is great variability among individuals and among different phenotypes of OA, courses of pain and physical functioning have been found to be predominantly stable, without substantial improvement or deterioration of symptoms over time.

[demiesworld]

hi guys! so i wanted to give you all this update as to why i have not been posting as much. for the past month i have been working at my job diligently, and at the same time ultimately concerned with my health and wellbeing. i know i made a post a while ago, saying that i was worried about my health and my kidney function, because i am a type 2 diabetic and kidney disease is common in my family. i have visited my new primary care doctor (for those who do not live in the US a primary care doctor is a healthcare provider that practices in general medicine and they are the individual i can go to to get check ups, vaccinations, referrals to specialists etc.) and a blood test as well as a urine test was done just last week.

the results of the blood test, my primary care doctor told me were fine. my urine test, to me told a different story, i noticed that my creatinine in my urine was low. it was at 17 when the reference range is 20 to 275 according to the lab test. anyways, i didn't ask them about my creatinine levels yet because i will be doing another visit with them at the end of this month to discuss over my results and what we will be doing as patient and doctor to make sure that i will be ok.

my blood sugar levels have been excellent. my respiratory is fine. my heart beat is normal. however i just have a really huge concern for my kidney function. until i get to see a kidney doctor who will do a test and the test informs me that i am well then i won't be worrying anymore. right now i am constantly stressing about my kidney function, i have been trying to distract myself with trying to finish writing requests, watching new anime shows, and going to the gym to put my mind off of it, but at the end of the night when my head hits my pillow it is all that i am thinking about.

i am writing this post to you guys, my followers and new followers, because i want for you all to know that i am still here. im still around, and i am trying my hardest to fulfill requests in my inbox and drafts. i am suffering right now from a really bad case of writer's block and stress. i think that is better to be transparent with you guys, and to let you all know what is going on with me.

i feel really bad that im not writing as often as i should be. i just hope, pray, and wish that this writer's block will go away and i will start writing again.

[dreadfutures]

right as I was writing a post about getting my health taken care of, Lu's new vet emailed me with his latest test results.

I've known about his liver disease for years, and we treat it with a low copper diet and supplements, but I always suspected his kidneys weren't right, either.

The tests confirm that he's in early stages of kidney disease too. :( My vet also shared my *previous* vet's medical records and shows that he's probably had it since at LEAST 2019, but it was never discussed with me.

SO that sucks.

Unfortunately renal disease is primarily treated with dietary changes, but Lu's already on a special low-copper liver disease diet so it's not just a "change to low protein" case. as far as I can find there's no liver care/kidney care diet that would work for him (he's also allergic to chicken, which is what a lot of kidney care diets are)

and on top of all of that--or because of it, since the REASON i suspected his kidneys had issues were his frequent UTIs--he has a UTI and I have to get it cultured to figure out what antibiotic to give him.

I just spent so much money on these blood tests for my poor old man and can't afford the urine culture yet so of course I feel bad letting it sit for another month until my next paycheck.

hoping I get a tax refund???? i guess???

i'm really annoyed about the previous vets never telling me about his heightened creatinine levels/etc that were indicative of renal disease. Like as far back as 2019, soon after I got him from the rescue, had heightened numbers and they were writing in their notes "suspected renal disease" but never told me. if i thought it meant anything, I would write 'em up for it. :(

[petfurri]

Captopril for Dogs: Benefits, Dosage, Side Effects, and More

Captopril for Dogs

Captopril is an angiotensin-converting enzyme (ACE) inhibitor commonly used in veterinary medicine to manage heart conditions in dogs, particularly congestive heart failure (CHF) and systemic hypertension (high blood pressure). Initially developed for human use, captopril has found its place in treating canine patients with cardiovascular issues, offering numerous benefits but also requiring careful administration and monitoring due to potential side effects.

Understanding Captopril and Its Mechanism of Action

Captopril works by inhibiting the angiotensin-converting enzyme, which is responsible for converting angiotensin I into angiotensin II, a potent vasoconstrictor. Angiotensin II causes blood vessels to narrow, leading to increased blood pressure and making the heart work harder. By blocking this conversion, captopril allows blood vessels to relax and widen, reducing the workload on the heart and lowering blood pressure. This action is particularly beneficial for dogs suffering from CHF, as it helps to improve blood flow and reduce fluid buildup in the lungs and other tissues.

Benefits of Captopril for Dogs

Managing Congestive Heart Failure (CHF): CHF is a common condition in dogs, especially in older or certain breeds like Cavalier King Charles Spaniels. Captopril helps manage CHF by reducing the resistance the heart faces when pumping blood, thus improving cardiac output and reducing symptoms like coughing, difficulty breathing, and lethargy.

Lowering Blood Pressure: For dogs diagnosed with systemic hypertension, captopril can effectively lower blood pressure, preventing damage to organs such as the kidneys, eyes, and brain, which can result from prolonged high blood pressure.

Improving Quality of Life: By easing the burden on the heart and lowering blood pressure, captopril can significantly improve a dog's overall quality of life. Dogs may exhibit increased energy levels, better appetite, and greater overall comfort as a result of treatment.

Potential Renal Protection: In some cases, captopril may offer renal protection by reducing the progression of kidney disease, particularly in dogs with proteinuria (protein in the urine), which is often associated with high blood pressure.

Dosage and Administration

The dosage of captopril for dogs must be carefully determined by a veterinarian, as it varies depending on the dog's weight, the severity of the condition being treated, and the presence of any other health issues. Captopril is usually administered orally, with or without food, typically two to three times a day.

Typical Dosage: The usual starting dose is around 0.5 to 2 mg per kg of body weight, given every 8 to 12 hours. The dosage may be adjusted based on the dog’s response to the medication and any side effects observed.

Monitoring: Regular monitoring is crucial when a dog is on captopril. Blood pressure, kidney function (via blood tests for creatinine and blood urea nitrogen levels), and electrolyte levels should be checked periodically to ensure the medication is working effectively without causing harm.

Potential Side Effects of Captopril

While captopril can be highly beneficial, it also carries the risk of side effects, particularly if not used correctly. Some of the potential side effects include:

Gastrointestinal Issues: Dogs may experience vomiting, diarrhea, or loss of appetite. These symptoms are usually mild but should be reported to the veterinarian if they persist.

Hypotension (Low Blood Pressure): As captopril lowers blood pressure, there is a risk that it may cause blood pressure to drop too low, leading to weakness, dizziness, or fainting. This is more likely to occur in dogs that are dehydrated or have other underlying health conditions.

Kidney Dysfunction: Captopril can affect kidney function, particularly in dogs with pre-existing kidney issues. It’s important to monitor kidney parameters closely during treatment to avoid exacerbating any renal problems.

Hyperkalemia (High Potassium Levels): Captopril can cause an increase in potassium levels, which can lead to dangerous heart rhythms if not managed properly. Regular blood tests are essential to monitor electrolyte levels.

Coughing: A persistent dry cough is a less common side effect but can occur due to the buildup of bradykinin, a substance that captopril can increase in the body.

Allergic Reactions: Though rare, some dogs may have an allergic reaction to captopril, manifesting as itching, rash, or swelling. Immediate veterinary attention is required in such cases.

Precautions and Considerations

Captopril should be used with caution in dogs with pre-existing kidney disease, dehydration, or electrolyte imbalances. It should not be used in dogs that are pregnant, as it can cause harm to the developing fetus. Additionally, it’s important to inform the veterinarian of any other medications the dog is taking, as captopril can interact with other drugs, including diuretics and nonsteroidal anti-inflammatory drugs (NSAIDs), potentially leading to adverse effects.