#exercise hypoxemia

[jinxed-sinner]

I've come across a few tiktoks that are basically "taking the main out of the main cast of Hazbin Hotel" and it never fails to be funny to me. Every single character design, whether they're a main character or they show up for less than 10 seconds, is super elaborate.

It's not like My Little Pony where the background characters aren't as interesting to look at as the main characters, so "taking the main out of the main characters" doesn't work. For the sake of showing what I mean, here are some of the background demons seen in Hazbin Hotel:

None of them would feel out of place in the main cast, frankly. Maybe in terms of color palette, but in terms of general design? They're no more or less designed than Angel, Alastor, Charlie, Niffty, Husk, Lucifer, or Vaggie, and their designs make you want to know more about them. Why does the first guy resemble an imp? Why is Vox's assistant an amphibian-like demon? How did the guy in the middle end up with a pocketwatch for a face? They're fun to look at because we have an idea of how Sinners get their demon forms, which makes Sinners fun to theorize on.

In addition to this, I think it's really fun to look at the background designs of Sinners because it allows you to analyze how they died and what they were like in life. In the main cast, Angel's a spider because his family were a mafia family (making the fact that they're all spiders a crime web joke). Al's a deer because he was killed by a hunter who mistook him for a deer while he was burying someone he'd killed on deer hunting grounds. Even taking minor characters where we know how they died, Baxter for example, Baxter's design is based on an anglerfish because he drowned on a ship in the 1910s (I read that Viv initially intended for him to have died on the Titanic, but didn't want to associate Hazbin with real-world events, so Baxter died on a ship similar to the Titanic in the 1910s). Personally I'd love to know how and when this one died.

(I think it'd be cool if she died from rabies in the late 2000s when scene culture was at its peak tbh. Died from rabies then ended up with an opossum form in Hell because opossums are resistant to rabies).

There is no "taking the main out of the main characters" in Hazbin Hotel because this is what the background characters look like. Even the simpler designs, like the first guy? Angel's white with pale pink highlights. Most of what makes his design is his outfits because he looks kinda plain without them.

It also makes Hazbin Hotel characters fun to design. I put so much thought into both Hazbin Hotel characters I've designed so far (those two characters being Juno and Psalm) and it's a really fun exercise in making every part of the design mean something. Juno is meant to be a husky because he died in Alaska, and he has a lot of blood motifs because he died from hypoxemia while skydiving (which is also why he has wings and feathers over his normal dog tail). Psalm is an axolotl because he died from a salmonella infection, and his outfit is because he worked at casinos Husk owned as an Overlord. Psalm's hair is also inspired by emo hairstyles because he died in the 2000s, when emo culture was at its height.

There aren't a lot of background character designs in Hazbin Hotel that don't make you wonder how they died, and I love it. I think it makes the show better, honestly.

[breathclinic]

Benefits of Supplemental Oxygen Therapy for Interstitial Lung Disease Patients

Supplemental oxygen therapy is a crucial component in the management and treatment of Interstitial Lung Disease (ILD), overseen by experienced specialists such as pulmonologist in Jaipur Dr. Pankaj Gulati at Breath Clinic. This therapy provides significant benefits to ILD patients by addressing the progressive decline in lung function and improving overall quality of life.

Understanding Interstitial Lung Disease (ILD):

ILD encompasses a group of chronic lung disorders characterized by inflammation and scarring of the lung tissue, which restricts the ability to breathe efficiently. Symptoms include persistent cough, progressive dyspnea (shortness of breath), fatigue, and reduced exercise tolerance. Causes of ILD vary and can include environmental exposures, autoimmune diseases, and idiopathic origins.

Benefits of Supplemental Oxygen Therapy:

Improved Oxygenation and Symptom Relief: ILD patients often experience hypoxemia, a condition where there is insufficient oxygen in the blood. Supplemental oxygen therapy helps increase oxygen levels, alleviating symptoms such as breathlessness and fatigue. By delivering a consistent flow of oxygen through nasal prongs or face masks, patients can perform daily activities with greater ease and comfort.

Enhanced Exercise Capacity: Adequate oxygenation is essential for physical exertion and exercise. Supplemental oxygen enables ILD patients to engage in physical activities and pulmonary rehabilitation programs more effectively. Improved exercise capacity promotes muscle strength, endurance, and overall cardiovascular fitness, enhancing quality of life.

Reduction in Pulmonary Hypertension Risk: ILD can lead to complications such as pulmonary hypertension, where increased pressure in the pulmonary arteries strains the heart. Supplemental oxygen therapy helps reduce pulmonary vascular resistance and alleviate strain on the heart, potentially lowering the risk of developing pulmonary hypertension.

Support During Exacerbations: During acute exacerbations of ILD, supplemental oxygen therapy provides critical support to manage respiratory distress and stabilize oxygen levels. This intervention can prevent complications and reduce the need for hospitalization, facilitating faster recovery and improved outcomes.

Long-term Management and Disease Progression: Continuous use of supplemental oxygen as prescribed by a pulmonologist in Jaipur like Dr. Pankaj Gulati is crucial in managing ILD progression. By maintaining adequate oxygen saturation levels over time, oxygen therapy may help slow disease progression and improve overall prognosis.

Enhanced Quality of Life: Improved oxygenation through supplemental oxygen therapy significantly enhances the quality of life for ILD patients. It allows them to maintain independence, participate in social activities, and enjoy hobbies without the limitations imposed by breathlessness and fatigue.

Conclusion:

Supplemental oxygen therapy is a cornerstone of Interstitial Lung Disease treatment in Jaipur at Breath Clinic, managed under the expert guidance of Dr. Pankaj Gulati. By addressing hypoxemia and improving oxygen delivery to tissues, this therapy not only alleviates symptoms but also supports pulmonary rehabilitation efforts and enhances overall well-being. ILD patients benefit significantly from personalized care and comprehensive treatment strategies that prioritize optimizing lung function and improving quality of life through effective oxygen therapy management. Early integration of supplemental oxygen therapy into ILD treatment plans underscores its role in enhancing patient outcomes and ensuring a proactive approach to managing this chronic lung condition.

[rehabilitation-and-nursing]

Pulmonary Care Program in NY

More than just writing prescriptions is provided by pulmonary care programs in New York. They use a holistic approach, attending to patients' emotional, physical, and educational needs:

Personalized Care Plans: Do away with generic medical interventions. The best programs customize strategies based on your individual needs, taking into account your lifestyle, general health, medical history, and present symptoms. A group of respiratory therapists, educators, nurses, and pulmonologists work together to develop a complete program that gives you the tools you need to take charge of your lung health.

The secret is education for empowerment. Top programs give you the information you need to properly manage your disease. You will gain knowledge about the particular pulmonary disease you have, how to take your medicine, recognize the early warning indicators of flare-ups, make lifestyle changes that can greatly enhance your lung health, and find support from others.

Superior Diagnostic Services Tests for pulmonary function (PFTs): Evaluate airflow and lung capacity. Bronchoscopy: A flexible tube is used to visually inspect the airways. Imaging studies: Chest X-rays and high-resolution CT scans for a thorough examination of the lungs.

Tailored Care Programs Medication management: Tailored drug regimens to control symptoms and avoid aggravating them. Exercise instruction, dietary guidance, and education are all part of pulmonary rehabilitation, which aims to enhance lung function and quality of life. Oxygen therapy is the process of giving people who have persistent hypoxemia more oxygen.

New York's Pulmonary Care Program, which offers cutting-edge diagnostics, individualized therapies, and a multidisciplinary approach to care, is the gold standard in respiratory health management. These programs enhance lung function and quality of life while offering a route to long-term health and wellbeing by attending to patients' emotional and medical requirements.

[drambikachestclinic]

COPD: Stages, Causes, Treatment

Chronic Obstructive Pulmonary Disease (COPD) is a progressive lung disease characterized by airflow obstruction, making it difficult to breathe. It encompasses conditions such as chronic bronchitis and emphysema. Here's an overview of its stages, causes, and treatment:

Stages of COPD (according to GOLD guidelines):

Stage 1 (mild):

Mild airflow limitation with FEV1 (Forced Expiratory Volume in 1 second) ≥ 80% predicted.

Symptoms may not be noticeable at this stage.

Stage 2 (moderate):

Moderate airflow limitation with FEV1 50-79% predicted.

Increased shortness of breath, coughing, and sputum production.

Stage 3 (severe):

Severe airflow limitation with FEV1 30-49% predicted.

Symptoms significantly impact daily life, leading to frequent exacerbations.

Stage 4 (very severe):

Very severe airflow limitation with FEV1 < 30% predicted or FEV1 < 50% predicted with chronic respiratory failure.

Severe symptoms, frequent exacerbations, and significantly impaired quality of life.

Causes of COPD:

Smoking: The primary cause, accounting for the majority of COPD cases.

Environmental Exposures: Long-term exposure to air pollutants, secondhand smoke, occupational dust, and chemicals.

Genetic Factors: Alpha-1 Antitrypsin deficiency, a rare genetic condition, can predispose individuals to COPD.

Respiratory Infections: Recurrent respiratory infections, especially in childhood, can contribute to lung damage.

Indoor Air Pollution: Exposure to biomass fuel combustion (e.g., wood, charcoal) in poorly ventilated homes.

Treatment of COPD:

Lifestyle Modifications:

Smoking Cessation: The most critical intervention to slow disease progression.

Pulmonary Rehabilitation: Exercise training, education, and support to improve symptoms and quality of life.

Avoidance of Environmental Triggers: Minimize exposure to air pollutants, dust, and other irritants.

Medications:

Bronchodilators: Open up airways and improve airflow, including short-acting (e.g., albuterol) and long-acting (e.g., tiotropium) bronchodilators.

Inhaled Corticosteroids: Reduce airway inflammation and help prevent exacerbations.

Combination Therapy: Some medications combine bronchodilators and corticosteroids for added benefit.

Oxygen Therapy: Supplemental oxygen to improve oxygen levels in the blood, particularly for individuals with severe COPD and low blood oxygen levels (hypoxemia).

Pulmonary Rehabilitation: Structured programs combining exercise, education, and support to improve symptoms, function, and quality of life.

Surgery:

Lung Volume Reduction Surgery (LVRS): Removal of damaged lung tissue to improve lung function and symptoms.

Lung Transplantation: For severe cases when other treatments are ineffective.

Preventive Measures: Annual influenza vaccination and pneumococcal vaccination to reduce the risk of respiratory infections.

COPD management aims to alleviate symptoms, prevent exacerbations, and improve quality of life. A comprehensive approach, including smoking cessation, medication management, pulmonary rehabilitation, and regular monitoring, is crucial for effective COPD treatment.

[lubdubmedical]

SpO2 Probes

SpO2, also known as oxygen saturation, is a measure of the amount of oxygen-carrying hemoglobin in the blood relative to the amount of hemoglobin not carrying oxygen. There are many ways that the blood can be tested to ensure it contains normal oxygen levels. The most common way is to use a pulse oximeter to measure the SpO2 levels in the blood. Pulse oximeters are relatively easy to use, and are common in health care facilities and at home. They are very accurate despite their low price point. A SpO2 probes, also known as a pulse oximeter probe or sensor, is a medical device that is used to measure a person's oxygen saturation level (SpO2) in their blood. It typically consists of a small clip or adhesive pad that is attached to a person's finger, toe, earlobe, or forehead, and contains a light emitter and a light detector. The probe works by emitting two wavelengths of light, one red and one infrared, through the skin and into the underlying blood vessels. Oxygenated and deoxygenated hemoglobin in the blood absorbs different amounts of light at these wavelengths, allowing the pulse oximeter to calculate the oxygen saturation level in the blood. SpO2 probes are commonly used in hospitals, clinics, and other medical settings to monitor patients who are at risk of hypoxemia (low oxygen levels in the blood), such as those with respiratory conditions or who are under anesthesia. They are also used by athletes and people with certain medical conditions to monitor their oxygen levels during exercise or at home.

Spo2 probe types There are different types of SpO2 probes, which can be categorized based on their design and application. Here are some common types of SpO2 probes: 1.Location: Finger probe, Earlobe probe, Toe probe, Forehead probe. 2.Method of measurement :Reflectance probe or Transmittance probe 3.Reusable probes or Disposable Probes 4.Additionally, some SpO2 probes are designed for use in specific clinical settings, such as MRI or surgery, and are constructed of materials that are safe for use in those environments.

Selecting the Correct Spo2 probe Here are some factors to consider when selecting a SpO2 probe: 1.Age of the patient: The size and design of the SpO2 probe will vary depending on the patient's age. Pediatric patients may require a smaller probe or a probe designed to fit on the earlobe or foot. 2.Medical condition of the patient: Patients with poor peripheral circulation may require a probe designed to clip onto a toe rather than a fingertip. Patients with thin skin or fragile skin may require a probe with a softer, more flexible design. 3.Location of the probe: The location where the SpO2 probe will be placed can also impact the choice of probe. For example, a probe designed for use on the forehead may not be appropriate for use on a finger. 4.Purpose of the measurement: The purpose of the SpO2 measurement can also influence the selection of the probe. For example, a probe designed for use during exercise may have a different design than a probe used during surgery. 5.Compatibility with the pulse oximeter: It is important to ensure that the SpO2 probe is compatible with the pulse oximeter being used. Some pulse oximeters may only work with specific probes, so it is important to check the compatibility before making a selection.

Lub Dub Advantage Lub Dub Medical Technologies has been the the business for over 29 Years. We are producing high quality SpO2 Probes that are compatible with the pulse oximeters made by different manufacturers. The requirements and preferences of doctors and patients are varied. Different scenarios call for different types of SpO2 Probes but we here at Lub Dub ensure that all your requirements are met and your expectations are exceeded.

[shawnbarai]

What is a normal oxygen level?

Normal A normal ABG oxygen position for healthy lungs falls between 80 and 100 millimeters of mercury( mm Hg). still, a normal reading is generally between 95 and 100 percent, If a palpitation ox measured your blood oxygen position.

still, in COPD or other lung conditions, these ranges may not apply. Your croaker will let you know what's normal for your specific condition. For illustration, it is n’t uncommon for people with severe COPD to maintain their palpitation ox situations between 88 to 92 percent.

Below normal A below-normal blood oxygen cylinder position is called hypoxemia. Hypoxemia is frequently beget for concern. The lower the oxygen position, the more severe the hypoxemia. This can lead to complications in body towel and organs.

typically, a PaO2 reading below 80 mm Hg or a palpitation ox below 95 percent is considered low. It’s important to know what's normal for you, especially if you have a habitual A condition or illness that arises sluggishly over days or weeks and may or may not resolve with treatment. It's the contrary of acute. lung condition. Your croaker can give recommendations as to what ranges of oxygen situations are respectable for you.

Is My Blood Oxygen Level Normal? – Health Line So what's the normal oxygen position? People who are breathing normal, who have fairly healthy lungs( or asthma that's under control), will have a blood oxygen position of 95 to 100. Anything between 92 and 88, is still considered safe and average for someone with moderate to severe COPD. Below 88 becomes dangerous, and when it dips to 84 or below, it’s time to go to the sanitarium. Around 80 and lower is dangerous for your vital organs, so you should be treated right down.

Your blood oxygen position will also go down a little when you're exercising unless your croaker has instructed you to turn your inflow setting up while you're exercising, making up for this change. Depending on the mo

[migrainepaininwestbloomfield]

The 5-second Trick for Migraine Pain in West Bloomfield

Mr. Zaslow and his authorities preserved that a non-contrast CT scan is not able to reliably diagnose or exclude the prognosis of aortic dissection and that is a lifetime-threatening affliction. Therefore, they argued that when the crisis health practitioner included an aortic dissection in his differential analysis it was incumbent on him so that the exam was executed.

Smoking cigarettes. People who smoke are thrice extra likely to have obstructive sleep apnea than are individuals who've in no way smoked. Smoking cigarettes can enhance the level of inflammation and fluid retention during the higher airway.

You might also come to feel speedy-tempered, moody, or frustrated. Kids and adolescents with sleep apnea may well conduct themselves improperly in school or have conduct troubles.

The wound demanded even further surgical treatment, maggot therapy along with pores and skin graft to close. Unfortunately, to be a consequence of the wound, our consumer created a severe, disabling scenario of CRPS affecting the concerned leg, ankle, and foot. She has undergone prolonged pain management, nerve blocks, medication remedies, spinal wire stimulator therapy, Bodily therapy, and holistic therapy modalities in her ongoing, but unsuccessful effort to further improve her problem. Mr. Crutchlow’s client continues to be disabled with Continual pain and weakness, has to miss her capacity to appreciate lots of her prior hobbies and pursuits, and is struggling to return to her task inside the pharmaceutical industry. Mr. Crutchlow retained gurus in Orthopedic Surgical treatment, Physician Assistant exercise, Pain Management/CRPS, and Economics from the prosecution of this circumstance on behalf of his clientele.

Zaslow claims he deposed the report’s author, Dr. E. Susan Hodgson, and would've sought to make use of her testimony plus the report at trial underneath the admission towards fascination exception towards the hearsay rule, due to the fact she is a point-out employee.

Betcher v. Casole: The spouse of the Union Seaside man who was killed inside of a car or truck accident having a professional farm truck that did not cease at an intersection agreed to a $one.8 million structured settlement final Monday with the truck driver and his mechanic.

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Abdominal migraine is thought to be a variant of migraine that's prevalent in children but unusual in Older people.

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The dilapidated gear and absence of non-public tumble protection triggered Plaintiff to slide close to 30 feet for the pavement underneath and put up with a skull fracture and traumatic brain injuries.

[fitconnmed]

A pulse oximeter is a small, clip-like device that you wear on your finger and measures your oxygen saturation, or the amount of oxygen in your blood. Normal oxygen saturation levels are between 95% and 100%. If your blood oxygen saturation is below 95%, it is considered hypoxic and you may need oxygen. Medical professionals use pulse oximeters to check a patient's oxygen levels, but they can also be used at home to monitor your own oxygen saturation levels. A variety of factors can cause your oxygen saturation levels to drop, such as altitude, smoking, certain medical conditions, and exercise. If you're interested in buying a pulse oximeter, this screen fingertip pulse oximeter from Fitconn can accurately measure blood oxygen saturation.

Introducing screen fingertip pulse oximeter

This screen fingertip pulse oximeter is a small portable device that measures the amount of oxygen in the blood. It consists of a sensor placed on the finger and a display that shows the oxygen level. The screen also shows your heart rate.

The screen fingertip pulse oximeter is used to measure the oxygen saturation of the blood. This is a non-invasive way to measure the delivery of oxygen to tissues. The normal range for oxygen saturation is 95-100%. A reading below 95% may indicate low oxygen levels in your blood (hypoxemia). The screen fingertip pulse oximeter can be used to monitor your oxygen levels if you have a lung condition such as COPD, asthma or pneumonia. It may also be used if you are at risk for hypoxia (low blood oxygen levels), such as if you are taking pain medication or have sleep apnea.

[silverlab101]

Lung Disease: Pioneering New Remedies

The third most frequent reason for dying on the earth, COPD is principally brought on by inhaling harmful substances similar to cigarette smoke (90% of cases) , particulate matter, or exhaust fumes. Direct or oblique exposure to tobacco smoke is a significant respiratory disease treatment threat issue for all lung ailments, as properly as other major NCDs, including cardiovascular disease, most cancers and diabetes. Effective tobacco control is essential to any strategy for preventing lung disease.

Patients in group C or D are at high danger of exacerbations and may receive a long-acting anticholinergic or a mix of an inhaled corticosteroid and a long-acting beta2 agonist. For patients whose symptoms are not managed with certainly one of these regimens, triple remedy with an inhaled corticosteroid, long-acting beta2 agonist, and anticholinergic should be considered respiratory disease treatment. Prophylactic antibiotics and oral corticosteroids aren't really helpful for prevention of COPD exacerbations. Continuous oxygen remedy improves mortality charges in patients with severe hypoxemia and COPD. Lung quantity discount surgical procedure can enhance survival rates in sufferers with extreme, upper lobe–predominant COPD with heterogeneous emphysema distribution.

Adequately powered, well-designed effectiveness research within the space of withdrawal of ICS from triple remedy are wanted to substantiate these findings. These future trials ought to consider necessary subgroups, together with patients with totally different frequencies and severities of exacerbations, blood eosinophilia, and asthma/COPD overlap. Evaluation of extra clinically essential outcomes, such as dyspnea, exercise limitation, and train tolerance, may provide additional insight into optimum medical administration. Respiratory issues, or lung ailments, are issues such as bronchial asthma, cystic fibrosis, emphysema, lung most cancers, mesothelioma, pulmonary hypertension, and tuberculosis. If left untreated, lung disease can produce health complications, problematic signs, and life-threatening situations. Patients could also be began on oxygen for the first time throughout hospitalisation for an acute exacerbation and discharged earlier than recovery is complete.

After World War II, VA and the Department of Defense carried out a significant study to check the effectiveness of the antibiotic streptomycin to treat TB. While preliminary results have been very favorable, researchers quickly learned that the antibiotic could trigger inner ear damage, and that many sufferers developed resistance to the drug. Respiratory problems are the main reason for dying in Veterans and others who have spinal twine damage . VA'sCenter of Excellence on the Medical Consequences of Spinal Cord Injury, situated in New York, is finding out ways to treat complications of SCI, together with those that affect respiratory. Veterans who develop respiratory most cancers and had been exposed to Agent Orange or different herbicides during navy service could also be eligible to obtain VA health care and incapacity compensation. 9 Things Your Pulmonologist Wants You to Know A pulmonologist makes a speciality of treating respiratory issues like bronchial asthma, COPD, emphysema and different respiratory problems.

Find a health analysis examine that is right for you at UMHealthResearch. It would be best to have Jasmine seen by a veterinarian, as I cannot see the expansion of determine what the cause may be. Having her seen and examined will enable the expansion to be checked out and have applicable treatment for her. Because these circumstances are sometimes transmitted by way of coughs and sneezes, it’s essential to cowl your cough or sneeze – ideally together with your elbow or a tissue quite than a bare hand. Influenza can be dangerous, even lethal, particularly in young children.

Respiratory signs could accompany other symptoms that change depending on the underlying disease, disorder or situation. Symptoms that regularly affect the respiratory tract may contain different body systems. If you have hassle quitting smoking, there are numerous options to help you, including gums, patches, and prescription treatment. Additionally, help groups and classes that can help you give up smoking can often be found through hospitals, workplaces, and community associations. To gradual the development of the disease, it's essential to stop smoking and avoid exposure to lung irritants. Treatment focuses on relieving symptoms, enhancing quality of life, and correcting way of life habits which will worsen the situation.

Third, few randomized trials have been revealed to guide management of COVID-19. The Surviving Sepsis Campaign guidelines have been up to date for COVID-19 . The WHO and the NIH also launched recommendations for the hemodynamic administration of COVID-19 patients. They each emphasised the importance of ultrasound to assess cardiac function and the necessity to assess fluid responsiveness to rationalize fluid management .

Another possible complication of a extreme case of COVID-19 issepsis. Sepsis occurs when an infection reaches, and spreads through, the bloodstream, inflicting tissue damage in all places it goes. Anyone who receives a COPD analysis should take motion to guard their lungs. COPD is irreversible, and people who smoke can reduce their risk by quitting as quickly as potential. People who smoke and have advanced respiratory disease treatment COPD might lose around 6 years of their life expectations, aside from the 4 years that smoking itself takes away, based on a examine revealed in 2009. COPD could be life-threatening, and a person’s life expectancy largely is decided by whether or not they smoke and the severity of present lung harm.

[sickcyclist]

This is the story of my day. It actually starts yesterday, when a heaven-sent rain swept in and cleared the smoke and cooled the air and tamped down the dust on the trails. I went on a bike ride because days like that are a gift. I have exercise-induced hypoxemia, which basically means that my oxygen drops when I exercise for reasons that we still don’t understand. Exercising with oxygen helps, but I still drop into the mid-80s. I knew I was too sick to ride and that doing so would make me much more sick, but I needed it for my mind so I was willing to sacrifice my body.

So that’s the first lesson of being sick. Everyone tells you that you have to be active and it will make things better and all you have to do is just push yourself hard enough. We’ve internalized this message to the point that many people believe sick people could get better if they just PUSHED. But that’s not always true. Sometimes pushing makes you worse. Sometimes it makes you much, much worse. And that can be true even if being active and pushing hard is something you love so much that it feels like it’s core to who you are.

I knew I would have to sleep for 12+ hours to make up for the ride, and I knew that I would have bad oxygen saturation stats because of it. And since I don’t have a real job, it should be easy to just take a lazy day (or week, or month) and get better, right? But actually I do have a real job and that job is to keep myself alive. It’s the job of a lot of us who are chronically ill, and it’s not a profession I would recommend. It’s not fun and it’s not rewarding and no one admires you for it and you’re not asked to speak to 5th graders on career day and you rarely get to move on to a newer, more interesting project.

Here’s what this particular day at work looked like for me. I woke up to a voicemail saying that my pulmonology appointment for Friday had been cancelled. I’ve been waiting to see a pulmonologist since March and was supposed to have an appointment weeks ago, but that was cancelled because the doctor quit two days beforehand. The other doctor in town couldn’t see me until the end of October, so I looked for a doctor in a bigger town hundreds of miles away. She comes highly recommended and in a way I’m happy because I strongly prefer female doctors, but for whatever reason she had to “clear her morning.” My new appointment is five weeks from now. I got off the phone and sobbed, which is not a good thing to do when your lungs don’t work. I probably could have toughed it up and avoided crying if I hadn’t worn myself down so much biking yesterday, but such is life.

I emailed my primary care provider asking for a note saying I could travel with my portable oxygen concentrator. I was supposed to get this letter from my pulmonologist, but now I won’t have a pulmonologist before I travel. The letter has to say that I use oxygen for sleep and activity, but it also has to specify that I won’t use oxygen on the plane. Which is a little funny because airplanes have extremely powerful oxygen-producing systems for emergencies, but they don’t like people who need oxygen because they don’t like the risk that comes with having sick people on board (think emergency landings). So people who need oxygen all the time need their own oxygen concentrator and battery power for the equivalent of 1.5x the time they will be in the air. I’m going on an 8-hour flight and it would cost about $400 to get strong enough batteries for that length. So I need them to let me carry my machine, which has lithium ion batteries that are otherwise prohibited. But in order to carry my machine I need to prove that I won’t be needing it.

I have a great primary care provider. I knew she would write the note. Easy peasy.

My next voicemail was from the specialty pharmacy that my insurance provider uses for certain drugs. I am allergic to a hormone all women produce as part of the menstrual cycle. This allergy is so severe that it has been responsible for 5 miscarriages, and it also means that I’m more miserable than usual for half the month. The good news is that all you have to do to stop it is take out your ovaries, but when you do that you go into full menopause. Which is not desirable because it increases your risk of cancer and osteoporosis and just overall mortality. Like not even from one thing. Just people who go into menopause early die early from all causes and we don’t know why.

That gives you some perspective on what the benefits have to look like in order for the cost-benefit analysis to still auger in favor of ovary removal. But since it is such a serious choice, you have to be sure. And the way you make sure is to stop your ovaries from working with a drug. The drug has hideous short and long term side effects, so if you feel better while taking it, that’s a pretty strong sign that an oophorectomy is the choice for you.

Approval for me to receive this particular drug was in limbo because the provider accidentally entered the wrong diagnosis. I have, as you can imagine, a lot of diagnoses. Entering the wrong diagnosis in this case was particularly funny because I’ve spent the last 6 months fighting with Blue Cross to get an expensive medicine that helps with my allergies. This medicine (Xolair) is approved for chronic urticaria (hives). It is not approved for progesterone hypersensitivity. I have both, which means I itch a lot for two weeks of the month and itch so much that I want to peel my skin off for two weeks of the month. Blue Cross argued that I wanted the drug for progesterone hypersensitivity. No medical provider said that, but it was the diagnosis they could use to deny the drug. Xolair costs $4000 a month. At that price it’s worth it to them to grind people down and hope they give up. It took four appeals and my lawyer (husband) to get the drug approved because I do indeed have chronic urticaria. It’s worked wonders for me, especially being allergic to the sun. You have no idea how easy it is to descend into madness when you are itchy all the time.

I went over all this with my new OB. I explained that, while the allergy shot solved the itching, it didn’t fix any of my systemic problems, which is why I was still interested in removing my ovaries. And because the conversation focused on how this ovary-suppressing drug (Lupron) specifically wasn’t for urticaria, it’s perhaps not surprising that she accidentally listed urticaria as the reason for the prescription. It’s like when you’re afraid you’ll mispronounce someone’s name. You tell yourself, “Say Kee-a, not Ky-a,” so many times that you’re basically guaranteed to call the person Ky-a.

So my ovary medicine was denied, of course, but I contacted my doctor’s office last week explaining the problem and they were very quick to apologize and resubmit. I returned the call from the specialty pharmacy but apparently they had just wanted to let me know that they were sorry for the delay. It was very polite of them but maybe didn’t require a phone call.

Then I got an email from Blue Cross Blue Shield. I logged in to read that coverage had again been denied (no reason stated) and that if I wanted to appeal the decision I would have to appeal through their specialty pharmacy. They gave me the name and number. Of a different specialty pharmacy than the one I had been dealing with for the past month. The one that I had already wrangled account numbers and diagnosis codes and special customer service phone lines out of. I typed up a polite response inquiring why I need to change pharmacies. And then I cried, but only just a little this time.

Then I called Walgreen’s because my medication for muscle spasms had been delayed and I received a note saying the pharmacist needed to speak to me. I am hypermobile so my connective tissue is just a little too bendy. My joints slip in and out all the time and my muscles have to overwork to hold my body together. Frequently they overwork so much that they lock up. This happens much more frequently in the progesterone-dominant phase of my cycle. Physical therapy is the best treatment, but sometimes I need muscles relaxants before I can even start physical therapy.

The man I spoke to at Walgreen’s told me I didn’t have a prescription for that drug. Then he told me I had a prescription but it had expired in March of 2020. I knew that wasn’t true because I hadn’t used it for years but had to start again when I got COVID. So I had no prescription in March of 2020 but I definitely did in March of 2021. No big deal. Just a simple computer error. Totally understandable in a pandemic, and I knew my doctor would refill it anyway. But he apparently felt that it was a big deal and wouldn’t submit the refill to my provider. I have no idea why. Maybe he thought I was engaged in drug-seeking behavior. Or maybe he was having a bad day. But he wouldn’t submit the refill. I hung up the phone and screamed. Loudly. Which really is not a good thing to do when your lungs don’t work.

Murry came up and rubbed the spasm out of my shoulder and listened to me vent and offered to be my medical power of attorney so he could deal with these people for me. But he’s the one with the real job that earns real money and when I’m sick he also cooks and cleans and does the shopping and walks the dogs. I may not be any good at the shitty job I had, but there’s no way I’m going to make him do it.

I switched tactics and chatted with someone through the Walgreen’s app. He was lovely and had no problem submitting my prescription for a refill. Easy peasy.

My final task for the day was calling to find out about the status of my CPAP prescription. I don’t have sleep apnea but while I’m asleep my breathing does slow down significantly enough that my oxygen drops (hypopnea). I need a special CPAP that adjust the pressure to my breathing, but it will get me off of oxygen at night. I’m very excited for it.

My insurance does not require prior authorization for CPAP prescriptions. However, St. Pete’s has its own prior authorization department that I guess makes sure you are not lying about not needing prior authorization? This department is, apparently, understaffed. I called my oxygen “rep” to find out how it was going. She very kindly bypassed the prior authorization department and called Blue Cross directly. Blue Cross informed her, as had I, that a prior authorization was not necessary. She could officially get me a CPAP.

Except that there is a national CPAP shortage. So she will try her best to get me one as soon as they get more. Hopefully this month. Even the rare, wonderful people who try to help you are sometimes as helpless as you.

I didn’t cry this time. Crying doesn’t fix anything and I can’t risk losing more oxygen. So I turned to writing therapy instead.

This was a bad day at work, but there are rarely good ones. It sucks to be sick, but I’m smart, articulate, overly educated, wealthy, and white. It could suck so, so much more. Someday I’ll turn all of this knowledge that I never wanted into something that helps people other than myself. Until then maybe someone will read this and know they are not alone. If being sick is your job, I see you. I would give you a hug—or a bonus!—if I could.

[mcatmemoranda]

Reviewing Questions:

Atelectasis pulls to the side of atelectasis, which one of the pulm fellows taught me. I answered a question that had a CXR that looked like pleural effusion, but it wasn't. It was atelectasis--actually, it was more than atelectasis, it was a collapsed lung. Collapsed alveoli will pull everything to the side of atelectasis, so you will see tracheal deviation to that side and hyperdensity the looks like pleural effusion on the ipsilateral side. Obstruction of the right main bronchus can cause lung collapse on the right. Pleural effusions push structures to the opposite side.

Pancreatitis can cause ARDS because the inflammation from pancreatitis activates neutrophils in the alveoli. Anything that causes inflammation in the alveoli-> ARDS. The neutrophils release cytokines that enhance inflammation, then you get hyaline membranes that inhibit gas exchange.

Exposure to asbestos-> asbestosis. Asbestosis can lead to mesothelioma, which is cancer of the mesothelial cells of the parietal pleural. But bronchogenic carcinoma is much likelier to occur than mesothelioma. I remember learning that in school and I think it was stressed in one of Dr. Plummer's lectures. But I still fell for the mesothelioma trap answer in this question. -_- Basically, asbestos exposure leads to pleural plaques, especially along the lower lung where the lung and diaphragm meet. Asbestosis is actually fibrosis of the lower lungs with asbestos bodies. Bronchogenic carcinoma is the most common cancer associated with asbestos, but mesothelioma is more specific for exposure to asbestos.

In sarcoidosis, you have noncaseating granulomas. Activated macrophages make 1,25-dihydroxyvitamin D-> increased absorption of calcium from the intestines-> hypercalcemia. Not only in sarcoidosis, but also in other granulomatous diseases, the activated macrophages for some reason have 1-aplha-hydroxylase, which they use to convert 25-hydroxyvitamin D to 1,25-dihydroxyvitamin D. Sarcoidosis also causes increased levels of ACE.

The theory is that idiopathic pulmonary fibrosis (IPF) is due to damage followed by abnormal healing. You get fibrosis, normal lung areas, interstitial inflammation, and honeycombing in the periphery of the lungs on imaging. Histo shows loss of type I pneumocytes and hyperplastic type II pneumocytes. So I think of it as the type II pneumocytes trying, but failing, to regenerate type I pneumocytes. It's common in people with a history of smoking. So constant injury and abnormal healing are thought to be the cause.

Adenocarcinoma is the most common lung cancer. It showed a slide and I thought the pt had either small cell or squamous carcinoma since she had a history of smoking. But you need to know what adenocarcinoma looks like histologically. It's adenocarcinoma, so it's glandular cells that you see on hitstology (adeno- = glandular).

Fever, cough, diarrhea, confusion = legionella pneumophila. It causes hyponatremia. Sputum stain will show neutrophils, but no bacteria on gram stain. It contaminates water, so look for history of being in a nursing home or going on a cruise. Culture it on Buffered Charcoal Yeast Extract (BCYE) or do a legionella urine antigen test to diagnose. Pontiac fever is acute; Legionnaires' disease is more common. Both are caused by legionella pneumophila.

Cavitary lesions (e.g., those that result from TB infection or emphysema) can be colonized by aspergillus fumigatus. Colonizing aspergillus-> aspergilloma (fungus ball). Invasive pulmonary aspergillosis occurs in immunocompromised pts and pts with neutropenia. Pts with asthma can have an allergic reaction to it--Allergic Bronchopulmonary Aspergillosis (ABPA). It's a mold whose hyphae branch at 45 degress angles!

A "brassy" cough (whatever that means) = laryngotracheobronchitis (croup), which is caused by parainfluenza virus.

Histoplasmosis appears in yeast form at body temperature; it repilcates in macrophages and travels in the lymphatic system; can cause hepatomegaly in immunocompromised pts. You can see all the yeasts inside a macrophage on light microscopy. It will grow hyphae on Sabouraud agar. Histoplasma capsulatum is associated with spelunking (exploring caves), where there is contaminated guano (bat droppings) and bird droppings. Occurs is the Ohio and Mississippi River Valleys. Dx with urine antigen or biopsy that shows the yeasts in macrophages.

Whooping cough (pertussis) can occur in adults who don't get vaccines updated. It's due to bordetella pertussis, a gram negative coccobacillus. Cough lasting more than 2 weeks and post-tussive emesis (vomiting after coughing) are signs of pertussis. It has a catarrhal phase (normal viral URI symptoms), paroxysmal phase (severe coughing with whoop or post-tussive emesis), and convalescent phase (cough improves).

Community acquired pneumonia (CAP) is usually caused by streptococcus pneumoniae. Neutrophils make myeloperoxidase, which accounts for the greenish color of the sputum in bacterial infections. Myeloperoxidase is a blue-green molecule that comes from the granules in neutrophils. It catalyzes the reaction that converts chloride and hydrogen peroxide into hypochlorous acid (bleach) in the respiratory burst.

From Wikipedia:

Myeloperoxidase (MPO) is a peroxidase enzyme that in humans is encoded by the MPO gene on chromosome 17.[5] MPO is most abundantly expressed in neutrophil granulocytes (a subtype of white blood cells), and produces hypohalous acids to carry out their antimicrobial activity.[5][6] It is a lysosomal protein stored in azurophilic granules of the neutrophil and released into the extracellular space during degranulation.[7] Neutrophil myeloperoxidase has a heme pigment, which causes its green color in secretions rich in neutrophils, such as pus and some forms of mucus. The green color contributed to its outdated name verdoperoxidase.

At high elevation, the oxygen content of the air is lower. So your blood will have less O2, thus cardiac output would increase in an attempt to get more oxygen to the tissues. Due to less O2 in the air, you would also get hypoxic vasoconstriction in the lungs, which would lead to increased pulmonary arterial resistance. Plasma volume also apparently goes down. So you hyperventilate, which leads to respiratory alkalosis. The kidneys respond by increasing HCO3- excretion. Hypoxemia also suppresses aldosterone which leads to diuresis and volume loss-> decreased plasma volume. Hypoxia-> Hypoxia Inducing Factor (HIF)-> increased erythropoietin.

Succinylcholine is a nicotinic ACh receptor agonist at the motor end plate. It causes depolarization until the end plate becomes desensitized and paralysis occurs. SUX is metabolized by pseudocholinesterase. Deficiency in pseudocholinesterase occurs in those with a genetic polymorphism (BCHE gene), so it takes longer for these pts to be able to breathe on their own again after receiving SUX. These pts also have prolonged effects from mivacurium and cocaine.

Neutrophil elastase is released not only by neutrophils, but also by macrophages. Didn't know that.

Varenicline (Chantix) is a partial agonist of the nicotinic ACh receptor (specifically the alpha 4 beta 2 nicotinic Ach receptor). It decreases cravings for tobacco and makes smoking less pleasurable.

Cromolyn prevents mast cell degranulation and can work for exercise-induced asthma or other acute asthma attacks. It doesn't work as well as inhaled corticosteroids.

The normal A-a gradient is 4 to 15 mmHg.

[breathclinic]

From Diagnosis to Recovery: Optimizing Interstitial Lung Disease Treatment Plans

From Diagnosis to Recovery: Optimizing Interstitial Lung Disease Treatment Plans" is a comprehensive exploration of the journey that individuals with interstitial lung disease (ILD) undertake, highlighting the critical role of pulmonologists like Dr. Pankaj Gulati at the Breath Clinic in Jaipur in guiding patients through every step of their treatment process. This insightful discussion delves into the intricate nuances of ILD management, from the initial diagnostic evaluation to the implementation of personalized treatment plans aimed at facilitating recovery and improving quality of life.

The journey of ILD treatment begins with a meticulous diagnostic process, wherein pulmonologists like Dr. Pankaj Gulati employ a multidimensional approach to ascertain an accurate diagnosis. This typically involves a comprehensive assessment of the patient's medical history, including risk factors, environmental exposures, and symptoms suggestive of ILD. Advanced imaging modalities such as high-resolution computed tomography (HRCT) scans play a pivotal role in identifying characteristic radiological patterns indicative of ILD, while pulmonary function tests (PFTs) help evaluate lung function and severity of impairment. In some cases, pulmonary biopsy may be warranted to confirm the diagnosis and elucidate the underlying pathology.

Armed with a definitive diagnosis, pulmonologists embark on the development of individualized treatment plans tailored to the specific subtype and severity of ILD, as well as the patient's unique needs and preferences. Dr. Pankaj Gulati, as a seasoned pulmonologist in Jaipur, collaborates closely with patients to formulate comprehensive treatment strategies that prioritize symptom management, disease stabilization, and preservation of lung function.

Central to ILD treatment is the judicious use of pharmacological interventions aimed at mitigating inflammation, fibrosis, and disease progression. Pulmonologists employ a variety of therapeutic agents, including corticosteroids, immunosuppressants, and antifibrotic medications, with the goal of alleviating symptoms and improving functional status. Additionally, emerging targeted therapies and biologic agents hold promise in addressing specific molecular pathways implicated in ILD pathogenesis, offering new avenues for personalized intervention.

In conjunction with pharmacotherapy, non-pharmacological interventions play a pivotal role in optimizing ILD treatment outcomes. Pulmonary rehabilitation programs, comprising exercise training, education, and psychosocial support, empower patients to enhance their physical fitness, alleviate dyspnea, and optimize their quality of life. Supplemental oxygen therapy may be prescribed to alleviate hypoxemia and improve exercise tolerance, with pulmonologists diligently monitoring oxygen saturation levels to ensure optimal therapy titration.

Throughout the treatment journey, pulmonologists like Dr. Pankaj Gulati remain steadfast advocates for patient education and empowerment, equipping individuals with the knowledge and resources needed to actively participate in their care. Regular follow-up visits enable ongoing assessment of treatment efficacy, disease progression, and potential adverse effects, allowing for timely adjustments to the treatment plan as needed.

Ultimately, the goal of ILD treatment is to achieve disease stabilization, symptom relief, and preservation of lung function, thereby facilitating the journey towards recovery and improved quality of life for patients. Pulmonologists at the Breath Clinic in Jaipur, led by Dr. Pankaj Gulati, are committed to optimizing ILD treatment plans through compassionate care, personalized attention, and evidence-based interventions, ensuring that individuals receive the comprehensive support they need to navigate their journey from diagnosis to recovery.

[mangeshp7793]

What Impacted COVID-19 on Medical Second Opinion ?

Impact of COVID-19 on Medical Second Opinion in Healthcare Industry

New coronavirus disease outbreak (COVID-19) in 2019 caused by extreme acute respiratory coronavirus-2 syndrome (SARS-CoV-2) has posed a significant threat to the population and has a huge effect on the economy, GDP and industry worldwide. The World Health Organization (WHO) has announced that the pandemic of COVID-19 has a high transmission rate that threatens many lives. The association of the Spike-S protein in SARS-CoV-2 with the Ace-2 receptor found in the human lungs is the primary cause for the high transmutability. This is the primary reason or the largest obstacle in the health care sector and perhaps the biggest challenge for healthcare providers in 2020. In December 2019, Chinese health authorities told World Health Organization (WHO) of a mid-serious situation when a group of 40 patients with pneumonia had symptoms, most of them related to the Huanan Sea Food market. Looking at the current situation, China is not suffering from any industry worldwide deficit as the number of graph cases in China is stabilizing. The countries namely the U.S., India, Brazil, Russia and many others around the world are experiencing business decline and a decrease in GDP. Since the declaration of the pandemic, several nations including China, India, the U.S., Russia, Germany and others have entered the full lockdown state in order to minimize the spread of COVID-19 in several countries such as China, New Zealand and South Korea which have succeeded due to their tight laws and increased monitoring and the Chinese company Baidus has begun heat mapping which has made testing simpler.

According to the weekly epidemiology report of 9th February 2021 by World Health Organization (WHO) stated 3.1 million cases of coronavirus has been reported globally in past week, this brings to over 105.4 million reported cases and over 2.3 million patients are dead due to the coronavirus globally. The outbreak of COVID-19 is having a huge impact on the healthcare industry which also means need for medical second opinion because of the growing concern of patients.

The second medical opinion is the type of service or supplemental consultation that the patient gets following their primary diagnosis. After that, the patient may get a second medical opinion if the patient is displeased with the diagnosis or if more information is required in the case of any critical surgical procedures. There has been a recent rise in medical second opinion providers largely due to clinical, financial and legal risks associated in care. As we say “Second Opinions: Two Heads are better than one”. Because of the contagion nature of COVID-19 and the rising number of pandemic events and various new diseases, a second opinion is very common and encouraged by doctors. So, the demand for second opinion market has increased though the growth is anticipated to be increased at a higher pace then it is now but due to pandemic and lockdown globally, the growth was subdued. It has also been forecasted by research analysts that after pandemic, this growth will further increase due to COVID-19, people are now more conscious about their health, further more increasing prevalence of peripheral vascular disorders and growing importance on superior treatment outcomes, rising inclination for healthcare cost optimization and increasing prevalence of diseases due to change in lifestyle, growing number of hospitals all over the world are also expected to fuel medical second opinion market. Due to COVID-19, on the basis of disorders, cancer and especially (lung cancer) patients have been at the front position of using the technology (tele-medicine) to manage their diagnosis for years, also with growing concern of people cardiac disorders, diseases related to respiratory system and surgical interventions are going to get huge revenue in future. Apart from that, organ transplant opinion by primary doctor make patient concerned and in-turn patient will look for medical second opinion and increases the revenue.

IMPACT ON SUPPLY

The bulk of the consumer supply has been affected due to COVID-19. The lockdown imposed by many countries is the key reason why imports and exports for many markets have been slowing down. The medical second opinion market is extremely fragmented and the key players have used different tactics such as expansions, creative solutions, joint ventures, alliances, collaborations, acquisitions and others to expand their presence in the market.

Although, the ease of use, relatively low cost of doctor's telephone consultations and the ubiquity of smartphones make this an attractive option for monitoring patients and identifying problems at an early stage, there are important considerations with these devices that patients and providers may not be aware of the potential to have an impact on the successful implementation of such a monitoring programme.

These technologies as tele-medicine and online prescription are not halted during the pandemic and serve as a boon technology for human beings based on software’s and A.I., so the technology relies on the vast supply of medical case data to train the machine model, for that, machine learning and deep learning is utilized, this is done to train it’s algorithms and to find the patterns in the images and identify specific anatomical markers. Also to keep the vast amount of data stored, big data is needed. Medical reports and data can be transferred in the form of pdf, images and others. So accessibility for medical records were easy, only thing that was halted is to perform diagnosis tests as they were carried out in hospitals and reaching to hospitals during the pandemic time was not so safe.

For instance,

·         To keep the track of patient SpO2 measurement, we need to first train the model by using training data of a fit individual collected from various databases, hospitals data, surveillance and others. After that we can provide the tested data to machine which then provide us accurate results.

Via a detailed study of trends in a given digital image, imaging algorithms may produce metrics and outputs that fit radiologist analyses which can be useful for rapid diagnosis.

Supply of the data is somewhat complicated by COVID-19 owing to a worldwide lockout, quick access to hospital data is not necessary to train the machine learning algorithm and without that artificial intelligence cannot be applied. Supply chain for data is broken but this is not entirely so because much of the patient data is stored on cloud servers or databases, one may still approach officials and purchases the data, many websites such as Kaggle and github are instances that store data and are easily available to everyone. Also tele-medicine and online consultations helps a lot and their supply chain of data in the form of images or pdf was not hampered.

Better and increasing numbers of diagnostic procedures carried out is expected to drive the medical second opinion market growth and supply for new solutions

The capacity and performance of customized care, better treatments and treatment of patients is also expected to fuel development in the demand for portable physical exercise products such as SpO2 and bpm fit-bands and smartwatches, although measurement also improves the supply of second opinion medical devices. On the other hand, some restraints are:

·         Rising lack of awareness

·         Reluctance toward opting for medical second opinion in emerging nations

·         Frequent changes in the economic status of developing countries

·         Also, providing tele-medicine facilities in the under-developed nations can be challenging

·         High cost and reluctance of adoption of these systems

·         Due to COVID-19, easy accessibility of data from hospitals to train machine learning model is not possible

IMPACT ON DEMAND

The global market for medical second opinion market is mainly related to the high prevalence of the cardiovascular disease, high rate of obesity, major surgical advices, lungs & respiratory tract disorders and the growing need for minimally invasive procedures. Additionally, factors such as increased number of tough healthcare decisions, expensive tests are right or not and risky surgery and finally unsure about the diagnosis, government initiatives and support, increased demand for advanced treatments, research and increased clinical trials for new diseases and increasing players that are offering newer solutions will probably stimulate the market. Tele-medicine and online second opinion become lucrative to increase the demand during the COVID-19 pandemic and will remain be a boon technology in future. This technology has by this time already demonstrated there efficacy, accuracy and refinement of results, that’s why researchers, physicians and pathologists know the value of the technology and hence, they are looking to hasten their productivity and potentially improve their accuracy in diagnosis of clinical abnormalities and problems related with patients.

Furthermore, accruing proof suggests that a sub-group of patients with severe COVID-19 acute respiratory distress syndrome (ARDS) with hypoxemia might have cytokine storm syndrome. Certainly, 25–31% of COVID-19 patients displayed irregular blood clotting. Blood clots can break apart and lodge in the pulmonary organs as lungs, causing in pulmonary embolism, while clots from arteries can lodge in the brain, triggering stroke. While the lungs are “ground zero”, clots can form in organ systems from the brain to blood vessels. This is a major reason for the increasing concern in patients to look for secondary option to treat the disorder or preventive measures against the virus.

Additionally, it has been found in the study of direct SARS-CoV-2 infection of endothelial cells and diffuse endothelial inflammation. Subsequently, SARS-CoV-2 targets blood vessels, patients with pre-existing damage to those vessels such as from diabetes and high blood pressure, face a higher risk of serious disease as hematological blood disorders, this is another main dynamic factor powering the market growth presently by multiple biotechnological and pharmaceutical companies globally to accelerate drug or vaccine development processes for the COVID-19.

Global medical second opinion market is expected to gain market growth and not just because of COVID-19, although the impact of COVID-19 has increased the growth of the market but the demand for medical second opinion was also higher in the period of 2015-2020 due to increasing number of geriatric, diabetic and cardiovascular diseases, although it is not as high as it is now. Because of the COVID-19, a new respiratory disorder with lots of mystery, it is clear that after COVID-19 pandemic will get over, it will further boost the global medical second opinion market because of the awareness in people about diseases and the increasing concern for physical care. In the pulmonology sector and cardiac sector especially, the demand will be higher. The participation of various start-ups that make some apps and smart tracking devices as fit-bands are also tracking the SpO2 levels which will help in the expansion of blood flow measurement market and become the key factors backing to the growth of the market. The U.S., China and the U.K. are developing as popular hubs for healthcare innovations. Japan and South-Korea also holds the scope for the development of medical second opinion market in healthcare with skilled workers and technologies they possess. Growth in Asia-Pacific is expected to be fast owing to the demand of advanced technologies and increasing cases of cancer, lung cancer, cardiovascular diseases and diabetes. North America rules the medical second opinion market due to highly aware people, innovative healthcare infrastructure, favorable government initiatives and rising prevalence of diseases due to change in lifestyle in the region.

On the other hand, growing healthcare expenditure and amount of hospitals will further boost various opportunities that will lead to the growth of the medical second opinion market. Some companies are launching new products to increase their revenue by meeting the emergent need.

Globally the surge in the demand of medical second opinion market in diagnostics market is going to be observed due to the infectious nature of COVID-19 which could be spread via touch, mucous droplets, use of clothes among others and due to lockdown, the advancement and the pace for development which was expected is likely reduced, but in coming few years, the growth is going to be much higher with increasing awareness of health in people and more accurate results from A.I. and new product launches and smartwatches.         

Some of the applications which can increase the demand for medical second opinion are:

·         Increasing investments in telemedicine technologies

·         Rising modernization

·         Technological advancement in the healthcare sector

·         Rising R&D activities

·         Assessment of auto-regulation capability

KEY INITIATIVES BY MARKET PLAYERS DURING COVID-19

Major competitors currently present in the market are Medisense Healthcare Solutions Pvt. Ltd., Second Opinion International, Cigna, EMS | Elite Medical Services, WorldCare, Medix Staffing Solutions Inc., 2nd.MD, AXA, Medo Asia Sdn Bhd., Medisense, London Pain Clinic, Mondial Assistance, GrandOpinion, Penn Medicine, The Johns Hopkins University, Keio University, Toranomon Hospital and Cleveland Clinic among other domestic and global players.

For instance,

Medisense Healthcare Solutions Pvt. Ltd. as well as all the competitors is now focusing on corona consultation specifically and in turnhelp boosting the revenue for global medical second opinion market.

“During plasma exchange, the plasma of COVID-19 patients is replaced with donated plasma,” explains Maier. “This reduces the viscosity by normalizing the fibrinogen and other factors contributing to the stickiness and potentially may reduce clotting. Still, correlation does not mean causality and we need to study this in large trials to understand whether viscosity is simply a marker of disease or actually contributing to clotting.

Another recent study by Medisense Healthcare solution: “Here's How Night Time Artificial Lights Exposure May Elevate Thyroid Cancer Risk!!”, it states people living in regions with high levels of outdoor artificial light at night may face a higher risk of developing thyroid cancer, suggested the findings of a novel study. These finding comes from a study published early online in 'CANCER', a peer-reviewed journal of the American Cancer Society.

CONCLUSION

The COVID-19 virus is expected to have a long-lasting effect on each business field. The pandemic of COVID-19 forced people to deal with the confusion and regulation of the virus. The virus poses a risk not only to human health but has also created economic hardship and extreme mental pressure, people are losing their jobs and every industry has suffered, causing chaos in everyone's minds. It is now fashioned to wear masks and gloves since COVID-19 has established a modern hygiene method around the world. Although, it cannot be assumed that a second medical opinion is not needed sooner. However, considering the extremely infectious nature of the virus and the ease with which it spreads through droplets or even fomites to some degree, the demand from the medical second opinion and the healthcare sector continues to grow not only for diagnosis but also for R&D to produce a drug or vaccine for the virus. With a spike in the number of cases, countries can also adopt these instruments to track SpO2 amount such as those of South Korea and China in order to keep the number of cases in check. It can be used in diagnostics to provide precise, consistent and accurate results since it is based on a huge and previous amount of data. Patients mostly have their health insurance which is covering for their treatment having a second opinion helps lot in the situation. "Looking to the future, there is clear potential for the medical second opinion consolations & solutions to become mainstream tools in the treatment of COVID-19 patients."

[biogenericpublishers]

Anesthesia in Obesity by Özgür Oğul Koca in Open Access Journal of Biogeneric Science and Research

Review Article

Ideal weight (kg) = Height (cm) -100 (Male)

Ideal weight (kg) = Height (cm) -105 (Female)

Obesity 20% from ideal weight ↑

In TURKEY 35% of total population obese, 6% morbidly obese 38.5% of women 26.4% of men are obese

Obese (BMI 30 - 34.9)

Severely Obese (BMI 35 -39.9)

Morbid Obese (BMI> 40)

Super Obese (BMI> 50)

Ultra Obese (BMI> 60)

Mega Obese (BMI> 70)

Obesity-related problems

Pulmonary embolism

DVT

Cancer

Stroke

Sleep Apnea Syndrome

Osteoarthritis

Type 2 DM

Hypertension

Coronary artery disease

Metabolic syndrome

Hypoventilation syndrome

Airway and respiratory system affected [1]

Reproductive problems

Liver and gall bladder diseases

Increased cardiac output and blood volume cause an increase in the workload of the heart. Arterial hypertension and left ventricular hypertrophy develop because the increase in cardiac output (0.1 L / min for every 1 kg of adipose tissue) is provided by the increase in stroke volume. It causes pulmonary vasoconstriction due to increased pulmonary blood flow and hypoxia, pulmonary hypertension and corpulmonary.

Obesity-hypoventilation Syndrome (Pickwickian syndrome) is a complication of extreme obesity. It is characterized by hypercapnia, polycythemia due to hypoxia, right heart failure and sleepiness. These patients have weak respiratory stimulation and snoring and upper airway obstruction (obstructive sleep apnea syndrome) are observed during sleep. Obstructive sleep apnea syndrome causes an increase in perioperative complications: hypertension, hypoxia, dysrhythmia, MI, pulmonary edema, difficulty in airway patency during induction, airway obstruction during recovery If opioids and sedatives are used and the supine position is given, the risk of postop airway obstruction is high. Therefore, CPAP application should be considered until full recovery is achieved [1,2].

Factors Affecting Drug Distribution in Obesity

Increased cardiac output, increased blood volume, increased organ size and increased fat mass. Theoretically, excess fat deposits cause an increase in the distribution volume of fat-soluble drugs (benzodiazepines, opioids, thiopental, propofol). The increase in volume of distribution means that a higher loading dose is required for the same plasma concentration. However, the restricted blood flow of adipose tissue reduces the effects of increased adipose tissue on acute distraction and elimination of the drug.^[3] The distribution volumes and elimination half-lives of lipophilic drugs increased in obese patients.

The response of the central nervous system to the induction dose of thiopental in obese patients is not different from that of non-obese patients, so the dose of the drug should be chosen according to the ideal body weight, not the actual weight of the patient.

Summary

The dose of intravenous induction agents should be adjusted according to the needs of the patient, not by calculation of milligrams per kilogram. Since the clearance rate is expected to decrease due to the high volume of distribution, the frequency of maintenance drug administration should also be reduced. The distribution volume of the water-soluble drugs (neuromuscular blockers) did not change. However, to avoid drug overdose, water-soluble drugs should be given according to ideal body weight. The distribution of volatile anesthetics to adipose tissue is very slow. Volatile anesthetics can be stored in adipose tissue. However, prolongation of recovery is not expected from volatile anesthesia in obese patients due to the slow distribution to adipose tissue. Increased metabolism of volatile agents and hypoxia in obese patients explain the increased risk of halothane hepatitis in these cases [4]

Isoflurane and desflurane can be chosen in obese cases as they are the least metabolized volatile agents.

Caution should be exercised in using nitrous oxide in obese cases due to increased intrapulmonary shunts and oxygen requirement.

Care should be taken in the use of opioids due to the increased risk of postoperative hypoxemia and hypoventilation.

Story

Sleep apnea

Somnolence

HT, CHF, coronary artery diseases

GER, hiatal hernia

DM

Deep vein thrombosis

Physical examination

Respiratory system: Dyspnoea, orthopnea, cyanosis

Airway should be evaluated; Sits and is in a supine position

The neck is short and thick

Temporomandibular and atlantooccipital joint movements are limited

The top airlines are narrow

The distance between the mandible and the sternal fat pads is short

Pharyngeal and palatal soft tissues are abundant

Larynx may be in anterior localization

Language is big

Cardiovascular System

Hypertension, heart failure, angina It should be evaluated in terms of arterial and vein access. Large blood pressure cuff (cuff should cover 70% of the arm)

Arterial Catheter Tests

ECG Ac radiography Detailed biochemistry (KC func, Lipid, blood sugar etc.)

Blood Gases Respiratory Function Tests Position

20-30 Reverse Trendelenburg: Ideal Premedication: Gastric acidity (H2 antagonists, anticides) and gastric volume (metoclopramide) should be reduced Sedatives, hypnotics and opioids should be used with caution due to sleep apnea. Intubation [1,3]

Awake endotracheal intubation may be safe in patients with massive obesity, small mouth-short neck, sleep apnea, and patients with impaired pulmonary and cardiovascular function.

Fiberoptic intubation may be required.The ramp position can facilitate intubation. In obese patients, desaturation may develop rapidly during the apnea period during intubation, as lung volumes are decreased and oxygen consumption is increased.Therefore, the cases should be preoxygenated before induction and denitrogenation of the lungs should be provided. Induction agents should be short acting. Intubation should be confirmed with end-tidal carbon dioxide, as respiratory sounds may not be heard well.

Ventilation [1,2,3].

General anesthesia can worsen oxygenation by causing a decrease in functional residual capacity and impairment in the ventilation-perfusion relationship. Therefore, controlled ventilation with 50% oxygen is frequently applied in these cases. In these cases, controlled ventilation with high tidal volume provides better oxygenation. Even with lithotomy, trendelenburg and controlled ventilation in the prone position, sufficient oxygenation may not be achieved and the oxygen concentration is increased in these cases. PEEP should be used with caution. Excessive levels of PEEP may further increase existing pulmonary hypertension.

Regional Anesthesia

Due to the adipose tissue, the cue points are unclear so there may be a hassle In obese cases, the dose of local anesthetic to be used for epidural and spinal anesthesia should be 20-25% less than normal individuals, since epidural adipose tissue is excessive and epidural veins are large. In the sitting position, the localization of the midline and the insertion of the spinal needle is easier. Postop respiratory complications are less in regional anesthesia.

Postop Prefer regional techniques for pain control. Patient controlled analgesia may also be preferred. Be wary of respiratory depression. Make sure that the muscle relaxant effect is fully antagonized (perform neuromuscular monitoring if necessary) Monitor oxygenation with a pulse oximeter Position in a half-seated (45 degrees) recovery room (diaphragm load is reduced) The risk of hypoxia may continue for a few days postoperatively; Oxygen should be given routinely. Early ambulation should be provided There are risks of postop wound infection, deep vein thrombosis and pulmonary embolism.

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Some Tips To Improve Body Oxygen Levels Naturally

We are living in unusually challenging times of a global pandemic. Having strong immune system and a well-functioning respiratory system are the need of the hour. Now it is more important than ever to take appropriate measures as a support for your health. This blog aims to highlight some tips to enhance the lung capacity and boost immunity.

Heart is the most important organ in the body that circulates oxygen-rich blood to all the cells. The oxygen carried by the blood helps replace the worn out cells, supplies with energy, boosts the immune system, and more. This makes it important to ensure that your blood oxygen level is neither too high nor too low. There are ways that can help you increase your blood oxygen level naturally.

For a healthy individual, blood oxygen level usually is in the range of 95 to 100 percent. This indicates that your lungs, ticker, and circulatory system are working fine. However, individuals residing at higher altitudes or those with chronic illnesses, such as asthma or chronic obstructive pulmonary disease (COPD), or even Covid patients tend to have lower readings. Oxygen therapy is an essential medicine in treating Covid-19 affected patients, and the treatment must be started on anyone with oxygen saturation below 90 percent, even if there are no obvious signs of low oxygen levels in the individual. Oxygen therapy can be instrumental in saving the person’s life.

Hypoxemia is the term used to describe low oxygen level, which is a reading between 90 and 92 percent. Such a low reading necessitates supplemental oxygen, and a reading lower than 90 percent necessitates seeking medical attention right away.

Some ways to increase blood oxygen levels naturally:

Breathing exercises- Start a daily meditation routine that lays emphasis on deep breathing. Just 5-10 minutes of relaxed and focused breathing every day can boost your oxygen intake (by opening your airways) and ease stress.

Quit smoking- This is the best thing you can do for overall good health. You’ll see significant improvement in both your circulation and overall oxygen levels just in a span of two-weeks of having gone cigarette-free. Expect an increase in your lung function by up to 30 percent.

Eat foods with high iron content- Foods you eat or your diet can affect your blood’s ability to absorb oxygen. There are foods that can increase your blood oxygen. Fill up your plate with fresh, iron-rich foods, such as green leafy vegetables (kale, broccoli), fish, poultry, meat, and legumes.

Exercise- There’s no two ways about the fact that exercising regularly can improve your quality of life. Consult with your doctor before embarking on an exercise regimen, it should be tailored to your life in order for you to reap the most benefits. Regular physical activity helps increase your breathing rate and depth that translates to your lungs absorbing more oxygen, making you feel better.

It is important to strictly follow all Covid-19 health and safety protocols to avoid contracting the virus.

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Top Benefits of Oxygen Therapy

Surviving without oxygen is just not possible. While some people are blessed with healthy lungs, others may have breathing issues due to impairment of lung functionality. Oxygen therapy acts as a lifesaver for people with breathing difficulties. It not only increases the oxygen level in your body but also helps in improving overall health. 

Oxygen therapy is mainly recommended for people suffering from issues like COPD, sleep apnea, severe asthma, pneumonia, and pulmonary fibrosis. However, for people with severe anaemia, radiation injury, brain abscess, and more, hyperbaric oxygen in London may be ideal. 

If you are wondering how helpful is oxygen therapy for health, take a look at the top benefits below. 

·         Reduces COPD Complications

COPD patients go through a number of complications. The most common type of complications includes heart failure, pulmonary hypertension, cor pulmonale, and secondary polycythaemia. However, availing of oxygen therapy can help in significantly reducing these symptoms. Oxygen therapy can reduce secondary polycythaemia, lower irregular heart rhythms, and stabilize pulmonary hypertension,

Moreover, oxygen therapy can also prevent COPD symptoms from worsening and prevents hospitalizations. It helps in the reduction of various COPD symptoms such as shortness of breath, dizziness, depression, and fatigue.

Increases Survival Chances

Everyone wants to live longer. However, people suffering from serious issues such as COPD have reduced life expectancy. But fortunately, oxygen therapy or supplemental oxygen helps in increasing the survival chances of such patients. COPD patients having severe resting hypoxemia can avail the of oxygen therapy on a continuous basis and prolong their lives.  

Enhances Exercise Tolerance

The ability to increase exercise tolerance is another benefit of oxygen therapy for health. Not all people have the same exercise tolerance limits. While some people have more, others have very little exercise tolerance. Mostly the people with breathing issues have less exercise tolerance. It limits them from exercising effectively. However, availing of oxygen therapy can increase the exercise tolerance of such patients. It helps in effectively reducing their breathlessness and ultimately increases their exercise performance. 

More Safety during Air Travels

COPD patients often experience hypoxemia while travelling in an airplane. Hypoxemia refers to a condition in which the oxygen level in your blood decreases and you feel shortness of breath. Such a feeling can make your air travel quite difficult. However, thanks to oxygen therapy. It can help in dealing with these situations and make your air travel safer. Oxygen therapy helps in preventing severe hypoxemia and ensures comfortable air travel. 

Better Quality of Life

Both oxygen therapy, as well as hyperbaric oxygen in London, prove to be effective means of improving the overall quality of life. While most people have a perception that oxygen therapy provides you with oxygen only, it actually does much more. With an increase in oxygen level in your body, you can experience quality sleep. Moreover, it also helps in elevating your mood, enhancing your stamina, and increasing mental alertness. 

In addition to all these, it can even help you become more productive throughout the day than you normally are. Availing oxygen therapy can also enable you to enjoy your daily activities more. It makes you feel more independent and allows you to be sociable at all times.

Winding Up

By now, you must have gained an overall idea of the benefits of oxygen therapy for health. However, make sure to avail of oxygen therapy or hyperbaric oxygen in London only when you have a deficiency of oxygen. It is always advisable to get the recommendation of a healthcare professional before taking oxygen therapy. While there may be some side effects of the treatment, it proves to be greatly helpful for people with breathing issues.