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ramurosa · 8 months ago

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Okayyyy yaaaayyy.

I watched OHHC wayyy back as a tween as most people have. It was one of my first anime’s and this was before I had any idea about how the industry surrounding the anime and manga worked and before I knew how to pirate anything other than anime. So when I watched OHHC I adored it but it didn’t go father bc i was like! 13! And unaware of fandom spaces!

I tried to read it about half a year back but I got busy. The reason I’m starting again now is because I was rewatching some of the anime episodes. I do… love it a lot… it has its issues as many older media (it’s not even that old) have, but I can deal with distasteful jokes or outdated/insensitive terms well, so it’s not an issue for my consumption of it, but that doesn’t mean it’s not an issue or harder to read for others.

This entire thing is a bit weird to write because I feel a lot of fondness and love for this entire series but I don’t know how to put it into words… it’s kind of perfectly tailored to me, it’s the type of media I really identify myself with, especially Tamaki… I like him so much because he feels like some other flamboyant version of me, one that my flaws won’t really allow me to be (born to be a flamboyant boy, forced to be a socially awkward girl. Many such cases). Not to get to into this train of thought but my dad is really into spiritual stuff, I call it his hyperfixation and I don’t believe in it the same way he does (wrong wording here. I may believe in it in a way but I also think it’s a bit too constricting sometimes when it comes to the gender stuff. It’s like the spiritual version of those guys who take one biology class and then begin to insist there are only 2 genders because there’s only 2 chromosome options. I digress.) but I do believe there is some element of truth in the inherent feminine and masculine in nature. And whatever Tamaki is, it feels like that masculine part of me. Which is funny because he’s definitely trans. This is such a long winded way to say I feel gender envy for an anime character, but I swear it’s more than that. I wouldn’t really label myself as trans, but I am whatever this is. I don’t know what it is… but I hope it illustrates the intimate connection I feel to this media, even if just a little.

Back to OHHC, because I wanted to do some simple comparing on the visual side of things! First off, if you were an weeb in the 2010s (and I say this from a western perspective. I don’t know much of anything about the domestic success of OHHC but I think that doesn’t matter for now as 1 series can take on different lives depending on the audiences consuming it. I also think older manga and anime fandoms may have been more in touch with the JP side of things, simply because that was the only way to get more content, and that isn’t necessary anymore with the current mainstream status of anime and manga. Even so, the reception of any given media by a western audience is automatically different from that of the intended Japanese audience. So I still believe my nostalgia filled vision of 2010s OHHC through my 13 year old mind is inherently authentic.) and even just a bit artistically inclined, you’d know the OHHC anime art style is iconic. In general, the animation is very good. But the art style is very different from the manga. That’s not unusual, but these days, anime adaptations almost always look infinitely worse than the manga. Older series don’t suffer from this as much, and I think that may be because people want exact copies of their favourite mangas these days. I think that may be because of anime’s rise to mainstream, but to be fair, the lack of artistic nuance in media is a pretty global thing. It’s something that ebbs and flows with the tides of history. C’est la vie. (Also still want to be clear there have been some beautiful anime’s especially this, and last year, so maybe the tide is turning, but it definitely wasn’t like this back in 2020.)

I keep going on tangents, but what I think is the primary reason behind the style change between the OHHC anime and manga, is to simplify it and make animation easier. It retains the typical bishonen look but its shape language is simplified to make more time for the animation of movement. There’s a lot of dramatised flailing around in OHHC that wouldn’t have been possible to animate if they decided to follow the manga more closely. The simplified shapes and flat colours make for really good and recognisable silhouettes.

Two more secondary notes: god the panelling sucks. Most older manga have abysmal panelling and OHHC isn’t worse relative to other works. But it’s definitely bad. Panelling has become more appreciated in recent years which is really good to see, and makes reading this stuff all the more nostalgic.

Second note is that as far as i can tell, they redesigned the twins! I need to give the manga a bit more time to be sure, because the earliest chapters of a manga tend to look a lot different from the rest, but I thought it was a really funny immediate change. Because manga Kaoru and Hikaru are UGLY!!! I’m so sorry! I hate their fuckass bowl cuts! I love them but not their bowl cuts. I’m sure this too will change and improve (I’d be surprised if their anime appearance wasn’t at least inspired by how they look in the manga. It’s adapted up until volume 8, so I will revisit this point when I get there.), or maybe I’ll learn to love the bowlcut. Either way, funny!

These are my thoughts rn. I’ll read chapter 2 later today.

Decided I’m gonna read 1 chapter of Ouran highschool host club a day bc I’ve been wanting to read this manga for way too long. I’ll be fine in late November let’s hope I can keep this up

I have a lot of thoughts regarding this manga… but that’ll come tomorrow. It’s almost 6 am and I am very tired.

#1 OHHC a day #im sorry for going on so many tangents!

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windingriverherbals · 5 years ago

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The Illustrated Herbiary Collectible Box Set: Guidance and Rituals from 36 Bewitching Botanicals; Includes Hardcover Book, Deluxe Oracle Card Set, and Carrying Pouch (Wild Wisdom)

Rosemary is the smell of deja vu and the after-breath of nostalgia. Her gift is the faint scent that teases and vanishes, leaving you longing for something you can’t quite name, with memories that crest and crash, pulling you gasping into their undertow.

In Victorian times Rosemary was said to say, “Remember me.” This is but a small part of her magic. Rosemary can ease remembrance, softening sharp edges, or she can dredge the distant past, pulling on your DNA to bring forward the longings of lineage. Crush the leaves. Hold them to your nose. The past is encoded into our cellular memory. Rosemary whispers, Sink into the knowledge that lives in your bones. Let memory rise up from the body of your being.

Honoring Ancestral Memory {Ritual}

Rosemary’s magic lies in her scent and the volatile oil hidden in her leaves. Science has affirmed that the smell of Rosemary’s essential oil enhances memory. Here’s how it works; When you inhale Rosemary, her vaporous oils cross through the mucous membranes in your nose and enter your bloodstream. Recall is significantly improved with Rosemary flowing in your veins.

You can get a good whiff of rosemary by crushing fresh leaves between your fingers or by rubbing a drop of rosemary essential oil between your palms. Then hold your hands over your nose and inhale for a few minutes. Notice how you feel.

Remembering Your Lineage

Connect with your ancestral past through freewriting. Her’s how: Grab a notebook and set a timer for 10 minutes. Below is a prompt to start your writing. After you read it, begin writing and don’t stop until your timer goes off.

I can almost guarantee that you’ll feel silly or lost or confused for at least the first 3 minutes. You’ll feel like you are making things up, or that you don’t know what to write. Keep writing. At a certain point, your ego will step aside and that is when the magic happens.

Hee’s your writing prompt: Dear {name of ancestor}, I’m working to deepen my ancestral ties. Is there anything you’d like to share with me? Now start writing, answering in the voice of your ancestor.

You Are Made Of Memories {Refection}

Rosemary whispers the memories of this lifetime, but she also reminds us of the kitchens of generations past and the scent of camphor mixing with sea air. Our DNA has traveled through millennia. When we think of memory, we focus on the people we ourselves have known – grandparents, great-aunts, cousins twice removed. Our thoughts tend to be based on personalities, experiences, likes or dislikes. Rosemary asks us to travel beyond those associations to feel for the memory that lives in the twisting threads of our chromosomes. This is what it means to honor our ancestors and to be rooted in our own history.

What if your bones are ancient bedrock and your laugh the wild wind? What if you are not only an individual but the present incarnation in a long lineage?

Rosemary Oil; Benefits of Therapeutic Use

Rosemary is a fragrant herb that is native to the Mediterranean and receives its name from the Latin words “ros” (dew) and “marinus” (sea), which means “dew of the Sea.” It also grows in England, Mexico, the USA, and northern Africa, namely in Morocco. Known for its distinctive fragrance that is characterized by an energizing, evergreen, citrus-like, herbaceous scent, Rosemary Essential Oil is derived from the aromatic herb Rosmarinus Officinalis, a plant belonging to the Mint family, which includes Basil, Lavender, Myrtle, and Sage. Its appearance, too, is similar to Lavender with flat pine needles that have a light trace of silver.

Historically, Rosemary was considered sacred by the ancient Greeks, Egyptians, Hebrews, and Romans, and it was used for numerous purposes. The Greeks wore Rosemary garlands around their heads while studying, as it was believed to improve memory, and both the Greeks and the Romans used Rosemary in almost all festivals and religious ceremonies, including weddings, as a reminder of life and death. In the Mediterranean, Rosemary leaves and Rosemary Oil was popularly used for culinary preparation purposes, while in Egypt the plant, as well as its extracts, were used for incense. In the Middle Ages, Rosemary was believed to be able to ward off evil spirits and to prevent the onset of the bubonic plague. With this belief, Rosemary branches were commonly strewn across floors and left in doorways to keep the disease at bay. Rosemary was also an ingredient in “Four Thieves Vinegar,” a concoction that was infused with herbs and spices and used by grave robbers to protect themselves against the plague. A symbol of remembrance, Rosemary was also tossed into graves as a promise that loved ones who passed away would not be forgotten.

It was used throughout the civilizations in cosmetics for its antiseptic, anti-microbial, anti-inflammatory, and anti-oxidant properties and in medical care for its health benefits. Rosemary had even become a favorite alternative herbal medicine for the German-Swiss physician, philosopher, and botanist Paracelsus, who promoted its healing properties, including its ability to strengthen the body and to heal organs such as the brain, heart, and liver. Despite being unaware of the concept of germs, people of the 16th century used Rosemary as incense or as massage balms and oils to eliminate harmful bacteria, especially in the rooms of those suffering from illness. For thousands of years, folk medicine has also used Rosemary for its ability to improve memory, soothe digestive issues, and relieve aching muscles.

Rosemary Essential Oil’s chemical composition consists of the following main constituents: α -Pinene, Camphor, 1,8-Cineol, Camphene, Limonene, and Linalool.

α -Pinene is known to exhibit the following activity:

Anti-inflammatory

Anti-septic

Expectorant

Bronchodilator

Camphor

Cough suppressant

Decongestant

Febrifuge

Anesthetic

Antimicrobial

Anti-inflammatory

1,8-Cineol

Analgesic

Anti-bacterial

Anti-fungal

Anti-inflammatory

Anti-spasmodic

Anti-viral

Cough suppressant

Camphene

Anti-oxidant

Soothing

Anti-inflammatory

Limonene

Nervous system stimulant

Psychostimulant

Mood-balancing

Appetite-suppressant

Detoxifying

Linalool

Sedative

Anti-inflammatory

Anti-anxiety

Analgesic

Used in aromatherapy, Rosemary Oil helps reduce stress levels and nervous tension, boost mental activity, encourage clarity and insight, relieve fatigue, and support respiratory function. It is used to improve alertness, eliminate negative moods, and increase the retention of information by enhancing concentration. The scent of Rosemary Essential Oil stimulates the appetite and is also known to reduce the level of harmful stress hormones that are released when involved in intense experiences. Inhaling Rosemary Oil boosts the immune system by stimulating internal anti-oxidant activity, which in turn fights ailments caused by free radicals, and it relieves throat and nasal congestion by clearing the respiratory tract.

Diluted and used topically, Rosemary Essential Oil is known to stimulate hair growth, reduce pain, soothe inflammation, eliminate headaches, strengthen the immune system, and condition hair to make it look and feel healthy. Used in a massage, Rosemary Oil’s detoxifying properties can facilitate healthy digestion, relieve flatulence, bloating and cramps, and relieve constipation. Through massage, this oil stimulates circulation, which allows the body to better absorb nutrients from food. In cosmetics for hair care, Rosemary Essential Oil’s tonic properties stimulate hair follicles to lengthen and strengthen hair while slowing the graying of hair, preventing hair loss, and moisturizing dry scalp to relieve dandruff. Traditionally, Rosemary Oil combined with Olive Oil in a hot oil hair treatment has been known to darken and strengthen hair. The anti-microbial, antiseptic, astringent, antioxidant, and tonic properties of this oil make it a beneficial additive in skincare products that are meant to soothe or even treat dry or oily skin, eczema, inflammation, and acne. Effective for all skin types, this rejuvenating oil can be added to soaps, face washes, face masks, toners, and creams to achieve firm yet hydrated skin that appears to have a healthy glow that is free of unwanted marks.

Rosemary Essential Oil’s refreshing and energizing aroma can be diluted with water and used in natural homemade room fresheners to eliminate unpleasant odors from the environment as well as from objects. When added to recipes for homemade scented candles, it can work the same way to freshen the scent of a room.

COSMETIC: Stimulant, Analgesic, Anti-inflammatory, Antiseptic, Anti-fungal, Anti-bacterial, Astringent, Disinfectant, Antioxidant.

ODOROUS: Anti-stress, Cognition-enhancement, Psycho-stimulant, Stimulant, Decongestant.

MEDICINAL: Anti-bacterial, Anti-fungal, Detoxifying, Analgesic, Anti-inflammatory, Carminative, Laxative, Decongestant, Antiseptic, Disinfectant, Antiseptic, Anti-nociceptive.

CULTIVATING AND HARVESTING QUALITY ROSEMARY OIL

Rosemary is a perennial bush that often grows on the sea cliffs of Spain, France, Greece, and Italy. The leaves of the aromatic Rosemary bush have a high oil concentration, and it is part of an aromatic family of herbs, which also includes Lavender, Basil, Mint, and Oregano to name a few.

Rosemary is a hardy plant that can withstand frost, but it also loves the sun and thrives in dry climates where the temperature is between 20ᵒ-25ᵒ Celsius (68ᵒ-77ᵒ Fahrenheit) and does not drop below -17ᵒ Celsius (0ᵒ Fahrenheit). Though Rosemary can grow in a small pot inside a home, when grown outside, the Rosemary bush can reach a height of approximately 5 ft. Due to its adaptability to various ecological conditions, Rosemary plants can vary in appearance in terms of their colors, the sizes of their flowers, and the aromas of their essential oils. The Rosemary plant requires adequate water drainage, as it will not grow well if it is over-irrigated or in soils with high clay content, thus it can grow in the earth that ranges in soil type from sandy to clay loam soil as long as it has a pH range of 5,5 to 8,0.

The upper side of Rosemary leaves are dark and the undersides are pale and covered in thick hairs. The tips of the leaves begin to sprout small, tubular pale- to deep-blue flowers, which continue to bloom in the summer. Rosemary Essential Oil of the most superior quality is obtained from the flowering tops of the plant, although oils can also be obtained from the stems and leaves before the plant begins to flower. Rosemary fields are usually harvested once or twice a year, depending on the geographical region of cultivation. Harvesting is most often done mechanically, which allows more frequent cutting due to higher yields from rapid regrowth.

Before distillation, the leaves are dried either naturally by the heat of the sun or by using driers. Drying the leaves in the sun results in poor quality leaves for producing oils. The ideal drying method involves the use of a forced air-flow drier, which results in better quality leaves. After the product is dried, the leaves are further processed to have the stems removed. They are sieved to remove dirt.

HOW IS ROSEMARY OIL EXTRACTED?

Rosemary Essential Oil is most commonly extracted through the steam distillation of the plant’s flowering tops and leaves. After distillation, the oil has a watery viscosity and can be colorless or pale yellow. It’s the powerful and refreshing smell is herbaceous and similar to mint with an undertone that is characterized as woody and balsamic.

USES OF ROSEMARY OIL

The uses of Rosemary Essential Oil are abundant, ranging from medicinal and odorous to cosmetic. Its many forms include oils, gels, lotions, soaps, shampoos, and sprays, to name a few suggestions for homemade products.

Used in aromatherapy, the woody, evergreen scent of Rosemary can promote relaxation and boost alertness as well as brain function, thereby improving memory. To relieve stress while studying and maintain concentration, diffuse Rosemary Essential Oil in the room for a maximum of 30 minutes.

Diluted with a carrier oil and used topically, Rosemary Essential Oil’s detoxifying and anesthetic properties can boost immunity by recharging the body’s detoxification system. By diluting Rosemary Oil in a carrier oil such as Fractionated Coconut Oil and massaging it into the lymph nodes, the body will be stimulated to more rapidly eliminate waste and to soothe digestive ailments. Its analgesic and anti-inflammatory properties make it an ideal essential oil for relieving muscle aches and pains. For a massage oil that reduces pain, blend Rosemary Oil with Peppermint Oil and dilute the blend in Coconut Oil then rub on tender muscles and aching joints.

Rosemary Essential Oil’s anti-viral, anti-microbial, and antiseptic properties make it a natural homemade multi-purpose cleaning spray to cleanse indoor environments and eliminate harmful bacteria therein. A dilution of Rosemary Oil in distilled white vinegar and water makes a spray cleaner that is suitable to wipe down surfaces like countertops.

A GUIDE TO ROSEMARY OIL VARIETIES & THEIR BENEFITS

ROSEMARY VARIETY & BOTANICAL NAME COUNTRY OF ORIGIN BENEFITS OF OIL Rosemary (Morocco) Essential Oil

Rosmarinus Officinalis

Found in:

Morocco

Believed to:

soothe inflammation

strengthen the body

eliminate harmful bacteria

Rosemary Essential Oil (Spanish)

Rosmarinus Officinalis

Found in:

Spain

Believed to:

improve memory

soothe digestive issues

relieve aching muscles

Rosemary Organic Essential Oil

Rosmarinus officinalis

Found in:

Spain

Believed to:

relieve nasal congestion

reduce fever

relieve muscle and joint pain

CONTRAINDICATIONS FOR ROSEMARY OIL

As per NAHA guidelines, we do not recommend the ingestion of essential oils. It is imperative to consult a medical practitioner before using Rosemary Essential Oil for therapeutic purposes. Pregnant and nursing women and those taking prescription drugs are especially advised not to use Rosemary Essential Oil without the medical advice of a physician. The oil may have a negative effect on the fetus and potentially lead to miscarriage. Rosemary Essential Oil should always be stored in an area that is inaccessible to children, especially those under the age of 7. Those with high blood pressure should avoid using this oil, as it may further elevate blood pressure.

When applied topically, Rosemary Essential Oil should be used in dilution – a carrier oil such as Almond, Coconut, Jojoba, Olive, or Hemp is recommended – and in small amounts, as using the oil directly or in high concentrations can potentially cause skin irritation. A skin test is recommended prior to use. This can be done by diluting the essential oil in a carrier oil and applying a small amount to a small area of skin that is not sensitive. Rosemary Oil must never be used near the eyes, inner nose, and ears, or on any other particularly sensitive areas of skin.

ROSEMARY ESSENCE…

Rosemary receives its name from the Latin term “Dew of the Sea,” as it is native to the sea cliffs of the Mediterranean region

Rosemary belongs to an aromatic family of herbs that includes Basil, Lavender, Myrtle, and Sage.

Rosemary was considered sacred by ancient Greeks, Egyptians, Hebrews, and Romans, who used it to improve memory, incense, protection, and as a reminder of the life and death cycle, among other uses.

Rosemary Essential Oil of the most superior quality is obtained from the flowering tops of the plant.

Rosemary Essential Oil is best known for its stimulating, soothing, and pain-relieving properties.

Rosemary, “Remember Me” The Illustrated Herbiary Collectible Box Set: Guidance and Rituals from 36 Bewitching Botanicals; Includes Hardcover Book, Deluxe Oracle Card Set, and Carrying Pouch (Wild Wisdom)

#Ancestor&039;s #Aromatherapy #book #health benefits #Herbal #Herbs #journal #lineage #Maia Toll #remembrance #Rosemary #rosemary oil #Rosmarinus Officinalis

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ithilthebard · 4 years ago

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Supernatural Universe - Fae

So I’d like to give a shout out to @theclockworkkid for their Golden Wind Merman AU. I made an OC; Indigo Bianca. Separate post coming later.

My natural DM instincts kicked in and I must make extensive lore even though I only created one character to exist within that universe. Indigo is fae and to the unaware is no different from a human upon first glance. Fae parallel the Pillar Men.

Fae Abilities

Teleportation - Must be a place they have been to before and have an emotional anchor of sorts.

Flight - Fae possess dragonfly-like wings (in appearance). Technically speaking they are not used for flight (as a bird flies) but are more so a conduit for their flight magic. Damaged wings will heal over time but until then the fae will be grounded.

Keen Senses - Fae are more in tune with the inherently supernatural and are thus often responsible for keeping the secrecy, small scale infractions are allowed and romantic relationships (with proper filing).

Shapeshifting - This is where changeling lore comes into play, children are not swapped at birth but some of those with fae blood may alter their appearance. Most have the ability to some degree, what most would consider glamorous or party tricks. The more inclined can appear as someone else entirely and few can even take on different forms. Some choose a druidic path and replicate different beasts while others explore the societies of other mythical creatures. The changes are not actively maintained. That is to say changes are permanent unless changed otherwise but there is always the “natural” or “base” state.

Magic Resistance - Unless willingly allowing it fae can rarely be affected by other’s (non-fae) magic. This is another reason why they are the keepers of secrecy.

Magical Affinity - Most supernatural species are capable of some degree of magic; the degree and range drastically vary. Fae are more inclined to broader types and strong extents. Some are generalists but most have an elemental specialty.

More detailed Lore below.

Gender is largely arbitrary to the fae and is mostly a preference of physical form. Hence Lord/King Kars and Queen Esidisi. Detailed records of breaking secrecy. Relationships (romantic/sexual) between different supernatural beings are reasonably commonplace but things must be taken into consideration when humans get involved. There aren’t fae courts, there is a singular ruler and all fae are loosely connected. Individuals are free to do as they please but many affiliate themselves with the crown because despite their mischievous nature the fae are known to be peacekeepers between various conflicts and the keepers of secrecy. And while primarily fae, other supernatural species also maintain secrecy but the keepers are typically more localized. The singular kingdom also relates to how they are few in number. There are few full blooded fae left, the royal family being a small example and while many carry fae blood it is recessive. Pure blooded fae are believed to no longer exist but full blooded are considered such if both parents were fae. The percentage of blood is arbitrary; a child with a fae ancestor from eons ago is just as likely to be fae as one with a fae grandparent. Though things can get complicated with other supernatural beings involved. Some couplings create hybrids but with the fae you either are or aren’t. If both parents possess fae blood the odds drastically increase unless other stipulations apply.

I made a conversation of a character explaining this.

“You also applied genetics to your mythology.” “Well a logical reason for there only being one kingdom on a global scale would be that the fae were scarce.” “But I don’t understand your ridiculous punnett square of if a child may be born a fae!” “One; it’s not a punnett square and two; it’s not ridiculous. You either aren’t a fae, have fae blood, and you may be a fae. If both parents are fae the child will be a fae. If other supernatural DNA is apparent then that will be dominant over the fae blood unless a parent is fae (possibility that either may occur). If there is fae blood from both parents the odds drastically increase but not if the other rules still apply.” “Why don’t you listen to some examples?” “Ella - 90% Human 9% Fae 1% Centaur & Frederick - 90% Human 9% Fae 1% Centaur, despite there being fae blood from both parents since centaur DNA is apparent the child will become a centaur if it is not human (most likely human). Anna - 99% Human 1% Fae & Arthur - 99% Human 1% Fae. One would expect a .01% chance of having a fae child but since there is no other supernatural DNA in play here and there is fae blood from both parents the odds are closer to 1% that might not be much but that’s still 100 times more likely than what one would expect. Indigo - 75% Human 25% Fae & Sirona - 75% Mer 25% Human, it is most probably for their child to be Mer but children could also be human or fae.” “But how does that work if being fae seems to be recessive?” “It isn’t. One could very much call it a roll of the dice, but I’m a Dungeon Master so I don’t care. But we don’t necessarily care about the percentage of fae blood. Generations will continue being fae no matter how diluted the blood is as long as both parents are fae. Genetics here work as a lineage rather than half of your 23 human chromosomes. Another example; 50/50 Human/Fae & 50/50 Human/Fae have a child that is fae. The child is 50/50 Human/Fae, just because the child is fae doesn’t mean they lose their human DNA. Hypothetically ‘half’ could be 5/45 Human/Fae from both parents resulting in 10/90 but this is fantasy, humans (usually) ruin (most) everything. Random chance does not get to fix their mistakes. And to whom it may concern the large majority of humanoid species are all compatible with one another.”

Faeries are not pixies. Pixies are small creatures known for mischief and pranks; they are also tiny, butterfly sized. Fae can use magic to make themselves small but are naturally humanoid sized. Kars can be a bit of an asshole but fae are largely keepers of order and peace despite a natural inclination to chaos (for their own amusement).

Also working on stands for the Ace Attorney characters.

#fantasy #fae #jjba #pillar men #au

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lauramalchowblog · 5 years ago

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“When Blood Breaks Down”: It Can Break Your Heart

By CHADI NABHAN, MD, MBA, FACP

“The goal for me and for my clinical and research colleagues is to put ourselves out of a job as quickly as possible”. This is how Mikkael Sekeres ends his book “When Blood Breaks Down” based on true stories of patients with leukemia. I share Mikkael’s sentiments and have always stated that I’d be happy if I am out of a job caring for patients with cancer. To his and my disappointment, this wish is unlikely to ever come true, especially when dealing with leukemia.

With almost 15 years of experience, Sekeres possesses a wealth of knowledge and patient stories making him the ultimate storyteller taking us along an emotional journey that spanned hospital rooms, outpatient clinics, and even his car. We get to know Mikkael the person and the doctor and immediately recognize how difficult it is to separate these two from each other. With hundreds of patients he has cared for, Mikkael could choose which stories to share. He decides on 3 patients, each with a unique type of leukemia and a set of circumstances that makes their story distinct. While I don’t know for certain, his selection likely reflected his ultimate goal of writing this book. It was about sharing life lessons he had learned from his patients–lessons that we could similarly learn—but it was also about giving us a glimpse of history in medicine and the progress that has been made in treating leukemia.

We get to know the three main characters of the book very well. David is an older man with acute myeloid leukemia (AML), Joan is surgical nurse who suddenly finds herself diagnosed with acute promyelocytic leukemia (APL), and Mrs Badway is a pregnant woman who was in her 2nd trimester when she was diagnosed with chronic myeloid leukemia (CML). While learning about their illnesses and family dynamics, Sekeres educates us about the various types of leukemia and enlightens his readers about so much history that I found fascinating. I did not know that the Jamshidi needle that I have used on so many patients to aspirate their bone marrows was invented by an Iranian scientist. Maybe I should have known, but I didn’t, that FISH was developed at Yale in 1980 and the first description of leukemia has been attributed to a French surgical anatomist, Dr. Alfred Velpeau in 1827. Somehow, I always thought that Janet Rowley discovered the Philadelphia chromosome, but Sekeres corrects me when he pictured Peter Nowell and David Hungerford who discovered that chromosome in 1961. As a reader, you might be more drawn to the actual patient stories, but the geek in me enjoyed the history lessons, especially the ones I was unaware of. Sekeres inserts these pearls effortlessly and with perfect timing. He does that so seamlessly and naturally that you learn without realizing you are being taught.

Sekeres’s abilities as a teacher become even more visible when he describes his interactions with the house staff and fellows on inpatient and clinic rounds. More specifically, the relationship between Sekeres and his fellow mentee Rachel is admirable. I grew fond of Rachel; she is an enthusiastic, hard-working, intelligent hematology oncology fellow that I would have loved to have on my service, but also the kind of person I would enjoy having a cup of coffee with to discuss life lessons. The way Rachel became aggravated with David’s son, Eric, who insisted on his dad getting chemotherapy reminded me of my younger self when I could not understand why families pushed for futile therapies. These days, however, I see myself more in Sekeres as he maturely handled the situation and taught Rachel the importance of understanding family dynamics.

Sekeres uses David’s story to discuss the difficulty of decision-making when older patients are faced with a disease that is rarely curable, especially when treatment is highly toxic and deadly. There are some interesting tutorials throughout David’s story; for instance, delaying therapy for AML patients over 60 years of age might not be detrimental. On the other hand, I was surprised to learn much later in the book that David has an IDH mutation and wondered why the author didn’t introduce genomic profiling early on. In fact, as I was getting to know David, I wondered what his genomic profile was and why it wasn’t discussed with his family at the time of diagnosis. In discussing treatment choices, Sekeres keeps us honest. He admits that physicians and patients oftentimes exaggerate the benefits of therapy and downplay the toxicity. It’s true and we all have seen it in our clinics; I applaud the author for bluntly telling us as such. In the end, the way David musters up the amazing courage to watch a long-awaited baseball game before he dies makes us wonder, but as if Sekeres read our minds, he asks the same question and confesses, “I have seen patients, even those moribund and comatose, linger for days until a daughter or son from overseas return”. We will never know why. We tear up as David loses his life to AML, but find serenity that even Eric, his hot-headed son, becomes peaceful and gives a thumbs up to Rachel.

Through Joan’s story, Sekeres teaches us about APL. Interestingly and contrary to what I had expected, Joan ended up having a relapsed disease. Patients with APL can often be cured with chemotherapy, but Joan wasn’t so lucky. I guess Mikkael was trying to tell his readers that even with a disease that can be cured in more than 75% of patients, we can see relapses, so get ready not to overpromise. We soon start learning about bone marrow transplantation and its various types and potential toxicities. The process of donating marrow was front and center in Sekeres’s mind. The author did not shy away from addressing controversial issues of storing an umbilical cord and whether transfusing blood products is acceptable in patients enrolled in hospice. In a semi “Soap Opera” twist, we learn something important about Joan’s story that could affect her ability to find a matched sibling donor, but I won’t spoil the surprise; you’ll need to read the book to uncover.

Last up is Ms. Badway, who has CML, a disease that is now treated with oral imatinib or its more potent “relatives and second-generation drugs”. Sekeres takes us down memory lane, making me remember when I heard Brian Druker giving the plenary session at ASH on the STI-571 (subsequently named Gleevec or imatinib) as he described a Phase I study of that agent showing unprecedented results. Interestingly, years earlier, Drucker was asked to leave the Dana Farber Cancer institute when his research was not funded. I bet the folks at the Dana Farber regretted that decision shortly thereafter when Drucker, now a faculty at Oregon Health and Science University reported on Gleevec. Ms. Badway’s pregnancy gives another twist to her story. Should she take the drug? Are there data on administering this drug during pregnancy? What about childcare? Compliance? Cost? Ms. Badway’s story brings up too many questions, so you’ll need to read for yourself to better understand the complexity of what might appear initially as easy decisions.

Overall, When Blood Breaks Down is easy to read, enjoyable, and a page-turner, especially if you are in the medical profession and have an interest in hematologic malignancies. I did wonder however if Sekeres was too technical in describing peer-reviewed data for the general public. I thought there were too many tables, Kaplan-Meier curves, and citations of actual publications that a lay person might get distracted from the true core of the book. I also thought that Sekeres could have discussed cost of care a bit more. He dances around the topic but doesn’t delve deep into the issue and how it might affect patients, nor does he offer solutions to rising drug costs. The focus of the book is certainly not health policy, but I wanted to learn more about the major characters as they navigated their health care costs.

With all of this in mind, I found the book a great read, with a wonderful collection of patient stories. The author has an amazing ability in storytelling and has so much compassion that I wanted to meet Sekeres and his team to make rounds with them. I read the book over a weekend and could not put it down. You will likely experience the same. I was left wanting to read more from Mikkael Sekeres and can’t wait for his second book.

Chadi Nabhan (@chadinabhan) is a hematologist and oncologist in Chicago whose interests include lymphomas, healthcare delivery, strategy, and business of healthcare.

“When Blood Breaks Down”: It Can Break Your Heart published first on https://venabeahan.tumblr.com

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kristinsimmons · 5 years ago

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“When Blood Breaks Down”: It Can Break Your Heart

By CHADI NABHAN, MD, MBA, FACP

Chadi Nabhan (@chadinabhan) is a hematologist and oncologist in Chicago whose interests include lymphomas, healthcare delivery, strategy, and business of healthcare.

“When Blood Breaks Down”: It Can Break Your Heart published first on https://wittooth.tumblr.com/

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fullmetalruby · 5 years ago

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an open letter to ms joanne, in the form of every question i’ve asked myself in the process of my current wip:

(this is really long)

what was the purpose of making house elves slaves?

if they’re based on brownies, as is the common theory, then what’s the narrative point of making them work for no pay? their situation as slaves was addressed, but never solved, and hermione was put down within the narrative for trying to solve it.

was the purpose just to give hermione a cause to fight for? was it an effort to make her seem more empathetic?

what are the hard limits on magic?

the only ones that are actually magical restrictions (as opposed to the one about gold, which was imposed by the ministry) are about immortality and resurrection.

we’re told that you can’t conjure food, but you can conjure plant (as shown by hermione in 7) and animals (as shown by hermione in 6) which can be turned into food, so what constitutes “food”?

HOW THE FUCK DO PREFECTS WORK

How are they chosen?

We know literally nothing. Are they nominated by their Heads of House and confirmed by the Headmaster? Do the Heads of House choose them outright, and if so, does the Headmaster have veto power? We know it isn’t an election, because Harry has no idea who the Prefects could be in 5th year, even though that would make the most sense.

Are there any pre- or co- requisites?

I would imagine that there’s at least a GPA/the wizarding equivalent requirement and, at the very least, an application, but we know that there isn’t one. Ron and Hermione are both surprised when they were chosen, though Ron moreso.

In this case, is there supposed to be a prereq and they just made an exception for Ron?

What exactly is their role within the school? What are their powers?

We’re told explicitly that they can’t take way points or give detentions, but we see them do exactly that. Do they actually have the power to do these things, or are their “orders” just referrals to the staff, who we know do have those powers?

Head Girl and Head Boy.

We know that the Head Girl and Head Boy can be chosen from the Prefects of the previous year, but they don’t have to be (see James Potter) and also that if they’re chosen from the Prefects of the previous year then they don’t necessarily have to be replaced as Prefects by another person in their year and House.

Are you allowed to say no?

Since there’s clearly no application process, no election, and no visible prerequisites that I can find, are you allowed to say no if you’re chosen as a Prefect? Are you allowed to quit partway through the year, and if so would you be replaced?

HOW THE FUCK DOES THE SORTING WORK

Harry says it’s based on where you want to go, but we saw it put Neville in Gryffindor even though he wanted to be in Hufflepuff, which would imply that it puts you were it thinks you would fit best, but we see Harry being told he belongs in Slytherin and being able to ask for Gryffindor.

How does magic itself work?

Can you get magical exhaustion? Is it like mana in video games, where you have a set amount you can use at any given time, or are you constantly drawing magic from the environment? or is it just an energy conversion from the energy your body contains? How do you recharge?

We know that items can have spells placed on them, but then what’s powering those spells (see above)? Does the item have to have magic of it’s own (like a battery) or does the spell draw from the caster? Can objects hold magic like batteries?

Where does magic come from? How can Muggles birth magic kids at all?

The fact that magic can be passed down through blood implies some genetic component, but the fact that we know people can go completely undetected as magical means they’re close enough that Muggle testing doesn’t detect it. The fact that Muggles can have viable children with wizard who themselves can then reproduce tells us that wizards and Muggles are close enough genetically.

So is the magic gene an extra chromosome? Are we supposed to infer that wizards are just the next stage of human evolution?

Following that, at what point will wizards and Muggles not be able to reproduce with each other/ start creating sterile children? When do we get the metaphorical mule?

ALSO squibs are supposedly rare but Muggleborns are very common. Is magic the dominant trait? If that’s the case then why are squibs so rare? Wouldn’t they be just as common as, say, redheads?

What, exactly, is the role of the Ministry at Hogwarts?

Ghosts

What’s their legal status? They’re clearly still sentient and retain the identities they had in life, so can they also retain any property they had in life? If you come back as a ghost is your spouse widowed, or are they technically still married?

How do you become a ghost? Can you stop being one? Do you have a choice in being a ghost?

At what point does the above indicated intelligence and sentience qualify/ stop qualifying someone as a “Being”?

HOW THE FUCK DOES LYCANTHROPE WORK

Specifically, what triggers the transformation?

Is it specifically exposure to the light of the full moon? Does it have to be a 100% full moon for this to work, or can it be a range e.g. of 97-100%?

Assuming this to be true, could a lycanthrope just stay inside and not transform?

Is it a psychological transformation? Does just knowing that the moon is full trigger the transformation?

Assuming this to be true, could keeping a lycanthrope unaware of the moon’s phase keep them from transforming?

From the above question, can lycanthropes sense when the moon is full?

If we assume so, then is it a yes/no type deal or can lycanthropes always tell how full the moon is? Can they tell you the exact percentage?

Can they sense the moon further? Can they tell you the time of day based on how long it will be until the moon rises?

What triggers the transformation back?

Is it exposure to the light of the sun, or is it specifically the absence of exposure to the moonlight? Or is it a set duration, e.g. once exposed to moonlight the transformation lasts for the next 12 hours?

Could you stick a lycanthrope in a basement and keep them transformed indefinitely?

What’s the extent of a lycanthrope’s power set outside of the full moon? Are they normal humans again, or do they retain any of the wolfishness?

Do they have heightened senses? Sharper teeth? Thicker hair? We know they retain a taste for rare meat (and that’s not even a full lycanthrope, it’s Bill) but how much further does it go?

This is in no way an exhaustive list, it’s just what I had off the top of my head. Please feel free to add on.

#harry potter

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liturgyontheweekend · 7 years ago

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When Harry Became Sally: Chapter 3

This chapter highlights the stories of a selection of detransitioners.

p49–52: INTRO

Anderson introduces the chapter, saying that voices of detransitioners deserve to be heard, and he’s going to present several of their stories. I don’t disagree that these stories should be heard, and I do think it’s sad that some trans activists have sought to silence these stories. I don’t think the media has helped, by trying to pit the two marginalized groups against each other, and I hope that the trans community can come to terms with these stories in a more inclusive way and that non-trans folks like Anderson can see these stories not in opposition to folks that are actually trans.

After reading the chapter, I’m definitely noticing that he’s only highlighting one type of detransition story, which works against his claim that he wants to showcase marginalized voices. He chooses six people, all of whom transitioned and then detransitioned because the transition didn’t feel right and didn’t address their underlying problems. He doesn’t share any stories of people who detransitioned due to social or family pressures, who may or may not still identify as transgender, and he doesn’t share any stories of people who detransitioned and then retransitioned.

And the elephant in the room is that he doesn’t share any stories of people who view their transition as successful and are living well-adjusted lives as transgender individuals. I can’t imagine his readers wouldn’t benefit from hearing those stories as well.

I’ll write very little about each of these.

p52–56: CARI

Experienced dissociative disorder. Transitioned due to gender stereotypes. She’s a lesbian.

I think it’s very clear reading this story that the medical profession fails people at times. She received poor care, and was rushed into transition.

p56–58: MAX

Transitioned due to gender stereotypes. She’s a lesbian.

Anderson did not reach out to her, and her comments when she found out her story was used included: “I’m not OK with it…I was not informed.”

She transitioned because she didn’t understand how she could live as a lesbian woman due to societal structures around her. And Anderson mentions that she’s careful to not discount stories of those who have transitioned and found it to be the answer for them.

p59–62: CRASH

Transitioned due to gender stereotypes and underlying trauma. She’s a lesbian.

Anderson did not reach out to her, and her comments when she found out her story was used included: “enraged to see my story distorted and used…would never have agreed to be included in such a book.”

She transitioned, she says, because she was harassed for being a lesbian and because her mom died by suicide. I feel like this story also highlights the need for better mental health care and perhaps a more cautious, measured approach to transition.

p62–66: TWT

Transitioned due to trauma. Experienced dissociative disorder.

Anderson did not reach out to him, and his comments when he found out his story was used included: “unaware my story was used to promote a political agenda…this happens a lot and it is not my intention.”

Another one which implicates bad doctors. No argument from me that we should have more good doctors and more comprehensive, high-quality health care.

While transitioned, he experienced much anti-trans discrimination.

p67–68: CAREY CALLAHAN

Transitioned due to trauma. Experienced dissociative disorder. Based on my reading elsewhere, I think she’s a lesbian.

Anderson did not reach out to her, and her comments when she found out her story was used included: “upset to be used as a rhetorical device by someone who does not respect me…enough to contact me.”

She questions young transition ages, since she got it wrong in her thirties. Anderson doesn’t share much of her story, but she appears to have been dissociative and hated her body. Her writings now are focused on hearing stories of detransitioners and responding to trans activists who try to shut them down.

p69–72: WALT HEYER

Transitioned due to significant childhood abuse. Experienced dissociative disorder.

Walt appeared on Christopher Cantwell’s podcast recently. Cantwell is a white supremacist who was part of the Unite the Right rally in Charlottesville, and said “we’ll f****** kill these people if we have to.”

I have very little to say to anyone who’s running in these circles. He should have had psychotherapy. He also shouldn't suggest that what was right for him is right for everyone.

p72–76: WRAPUP

The chapter title is “Detransitioners Tell Their Stories” but this is really Anderson telling their stories. He didn’t ask at least four of the six people if he could use their stories, and therefore they weren’t allowed to weigh in on whether his was a fair account. This is, at minimum, irresponsible journalism.

The only point he’s really made is that transitioning isn’t the solution to every problem. He admits that in the first sentence of this section, and then goes on to make an absolute claim, saying “trying to align the body with a transgender identity does not resolve the deep issues…” He needed to add “for these six people,” since there are myriad stories of people for whom it has resolved their deep issues.

On page 73, he again misrepresents the Swedish study which doesn’t say what he wants it to say. This time, it’s tough to say it’s not just a blatant lie. The study found that for those who transitioned post-1989, their rates of mortality, suicide, and crime are in line with the general population. I already talked about this in the Introduction email.

If we know that transgender people overall have a higher suicide rate than the general population, and there’s a Swedish study that Anderson seems to like which says that those who transitioned post-1989 have a rate in line with the general population, the only reasonable conclusion is that transitioning was helpful to these people, not harmful. Why does he keep saying the opposite?

He ends the chapter by quoting most of an open letter from Crash, who detransitioned and is lesbian, to Julia Serano, a transgender activist who she believes has misrepresented and been unfair to detransitioners. This is a heartfelt letter, and I did go read it in its entirety.

At the end of her letter, she openly acknowledges trans people, and also that she is not. She notes of those who eventually detransition: “so many of them are lesbian [and it’s] common for them to question whether they are really female.”

Anderson could start by working for an world in which folks like Crash feel validated and accepted for who they are, with full recognition and human rights, which would keep many lesbians like Crash from wondering whether they are really female and whether transitioning is the solution to their problems.

POSTSCRIPT

Finally, I took a look at the 2015 Transgender Survey, to find out more about detransitioning. 8% of over 27,000 respondents had detransitioned at some point in their lives, but 62% of those were currently living in a gender other than that assigned at birth. So we're in the 3–4% range for permanent detransitioning, since many detransition temporarily for some other societal reason. Only 5% of those who detransitioned did it because it wasn't right for them. 36% detransitioned because of pressure from a parent, 26% because of pressure from other family members, 18% due to pressure from a partner, 31% because of harassment, and 29% because of having trouble getting a job. (Respondents could cite multiple reasons, so the totals are greater than 100%). So a total of 0.4% of respondents to the survey detransitioned because transition wasn't right for them.

https://transequality.org/sites/default/files/docs/usts/USTS-Full-Report-Dec17.pdf

The small number of folks (less than half a percent) who actually detransition because they made a mistake DOES NOT invalidate or lessen the importance of their stories. They should be heard, and transgender folks need to engage with them. We should also do more to ensure that we create a safe world for gender-nonconforming and LGB people such that fewer people like Crash transition for the wrong reasons.

Folks like Anderson also shouldn't appropriate detransitioners' stories to attempt to build a case that nobody should ever transition; clearly there are lots of stories he's not telling from the remaining 99.6%.

FOLLOW-UP

I received a response which I then responded to; I can’t print the response but I’ll print my follow-up:

My overall point was that his selection of people to profile is limited. These weren't transgender people; they were people with psychological issues who tried to solve them in a misguided way and for a time believed themselves to be transgender. You can't select a non-representative sample of people (non-transgender people who transitioned), note their psychological problems, and then post-rationalize your conclusions onto another group of people (actual transgender people). Your comment about whether or not those issues "exist within the larger community" is exactly my point -- Anderson doesn't know because he doesn't bother to ask. Probably because he knows what that would do to his argument. Obviously, then, we disagree about his political purposes. Minor point, also, but nobody ever claims that transitioning will alter chromosomal makeup, so I think we all agree there. Anderson, to this point in the book, has not spoken with a single transgender person! I'll eat my hat if he does anywhere in the book; my guess is he'll continue his current trajectory. If he were truly trying to engage the subject rather than pushing a preconceived position, he'd spend some time with folks in the community he's writing about.

I also don't see any evidence based on what you sent over that R.B. is transgender. Unless you've got data to the contrary, you're pushing the same strawman argument that Anderson is. She may fall into that 80% percent of Zucker's research, people who show some nonconformity in childhood but aren't transgender, and end up settling into a straight or LGB+ identity. People who are straight/gay living lives as straight/gay people do not invalidate people who are transgender, and my issue here is that Anderson doesn't interview or profile any of the large number of actual transgender people who do not regret their transitions.

I know some of them, and can assure you they are nothing like the detransitioners that Anderson highlights.

SUMMARY OF MY POINT: Profiling non-transgender people to make claims about transgender people is a strawman. Detransitioners' stories are important for their own sake, not for the sake of an argument that doesn't make sense and that they don't want to be a part of.

#when harry became sally #lgbt

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yesilovehorses-blog1 · 8 years ago

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Equine OCD: Harmless Bone Lesion or Permanent Problem?

New Post has been published on http://lovehorses.net/equine-ocd-harmless-bone-lesion-or-permanent-problem/

Equine OCD: Harmless Bone Lesion or Permanent Problem?

Osteochondrosis is a common but often temporary disease of young horses’ joints.

Photo: iStock

Leading researchers from around the world share their findings on this common joint disease of young horses

"Growth itself contains the germ of happiness,” writes Pulitzer Prize novelist Pearl Buck.

Perhaps it does.

But in young horses, it might also include something a bit less appealing—chips of bone. Osteochondritis dissecans (OCD) is a common disease of domesticated horses characterized by loose cartilage and/or bone fragments in the joints. Fortunately, there’s a “germ of happiness” in the prognosis: Many OCD lesions heal spontaneously within a few months. Those that don’t, however, can cause permanent problems when not treated correctly.

How the condition manifests varies considerably from horse to horse, joint to joint, and lesion to lesion. And researchers say its severity and occurrence rates might be linked to breed, genetics, and environment. To give you a better understanding of this complex growth issue, we’ve put together the most recent work and viewpoints from the world’s leading researchers on this disease.

Getting the Terminology Right

First things first, let’s get a grasp on what’s what in the world of OCD and other growth-related conditions.

Integral to our understanding of OCDs is familiarity with osteochondrosis, a disease that causes lesions in the cartilage and bone of growing horses’ joints. When a lesion actually gets to a point where it separates from the underlying bone, it’s termed OCD.

These are two of the most common issues within a wider classification called juvenile osteochondral conditions (JOCC). Coined by Jean-Marie Denoix, DVM, PhD, professor and director of the Centre d’Imagerie et de Recherche sur les Affections Locomotrices Equines, in Normandy, JOCC groups together all developmental disorders related to immature joints or growth plates in young horses.

These disorders fit within an even broader classification of conditions known as developmental orthopedic disease (DOD). This 1986 term comes from the work of Wayne McIlwraith, BVSc, FRCVS, PhD, Dipl. ACVS, Dipl. ECVS, professor of surgery and director of Colorado State University’s Orthopaedic Research Center. The DODs encompass not only JOCC but also other orthopedic disorders related to development, such as Wobbler syndrome and limb deformities.

Just the Joints

Osteochondrosis is a disease of developing bone, but the only place we find it is in the joints. This has to do with the way bones grow and solidify through a process called endochondral ossification. As bones lengthen over time, they build epiphyseal cartilage at each extremity—the ends that meet the ends of other bones at joints. Little by little, the epiphyseal cartilage turns into true bone—the ossification process. In mature animals, only a thin layer of cartilage remains, covering the articulating ends of the bone within the joint. This is called articular cartilage. Problems during the ossification process can cause osteochondrosis and similar conditions.

Horses, of course, have dozens of joints, with each one uniting the ends of several bones. And every one of these joints contains one or more possible sites for osteochondral lesions, each with its own characteristics.

“Depending on the site at which lesions occur, the consequences, progression, and outcome may be different,” says Cathy Carlson, DVM, PhD, Dipl. ACVP, professor in the University of Minnesota’s department of veterinary population medicine, in St. Paul.

René van Weeren, DVM, PhD, Dipl. ECVS, professor in the department of equine sciences at Utrecht University, in the Netherlands, also stresses the great disparity in types of lesions. “Joints react differently, and even sites within joints are not always comparable,” he says.

That’s why Denoix came up with a new scoring system for osteochondrosis with weighted severity indexes (0, 1, 2, 4, and 8) for individual lesions. In doing this he revamped previous incongruous scoring systems. These new scores help veterinarians follow the evolution of lesions more closely and make better decisions about prognosis and treatment, he says.

So where in the horse is osteochondrosis most common? For the most part it’s pretty variable, depending on age and breed. Denoix’s recent study on hundreds of Warmbloods and Thoroughbred and Standardbred racehorses in France showed that osteochondrosis occurs in weanlings most often in the hind fetlock, affecting 28% of the foals. The second-most-common site in Thoroughbreds and Warmbloods was the front fetlock; in Standardbred trotters, it was the hock and the stifle.

The Big Problem: Failed Vascularization

Osteochondrosis develops in response to blood flow problems. Epiphyseal cartilage and young, new bone are heavily vascularized, meaning they are chock full of blood vessels, pumping in nutrients and taking out waste so as to allow growth.

When epiphyseal cartilage doesn’t get the blood flow it needs, osteochondrosis can develop, says Carlson.

The lack of blood flow “creates an area of cell death and matrix (internal bone structure) degeneration,” she explains. “That can make it unable to support the overlying articular cartilage, and it may collapse under pressure, leading to the formation of a cartilaginous flap, accompanied by pain.”

Why would such vascular failure happen? Kristin Olstad, DVM, PhD, of the Equine Section of the Norwegian University of Life Sciences’ veterinary school, in Oslo, has been working with Carlson to answer that question. So far it looks like a problem of missed connections. As the cartilage at the growing end of the bone develops, the blood vessels in that cartilage must link to the vessels in the underlying bone. Sometimes those hook-ups just don’t happen—for reasons yet to be determined, she says.

But that’s not the only way vascularization fails. Sepsis (bacterial infection), physical damage (such as frostbite), or trauma can also cause blood vessel dysfunction leading to degeneration.

A Selected For Problem

The latest research on osteochondrosis is revealing some staggering figures: As many as 50% of Standardbreds and Dutch Warmblood foals, for example, have osteochondral lesions, says Carlson.

“It is a serious problem,” she says, and one that we keep reproducing year after year through bloodlines. “The disease has a heritable predisposition, so it’s important, in particular, for breeding animals,” Carlson notes.

Also, says van Weeren, it’s a disease that’s almost exclusive to domesticated horses. Wild horses have occurrence rates of around 2% in certain joints, down to zero in others. Ponies (even domesticated ones) are mostly exempt from the disease, he adds.

What does that mean? The statistics strongly suggest that we’ve—accidentally, of course—specifically selected for the genes that cause osteochondrosis, perhaps by breeding for larger, faster-growing animals.

Unfortunately, selective breeding probably won’t help at this point, our sources say. “There’s little hope of eradicating the problem by breeding strategies alone, as environmental factors are known to play a large role and because the disease is definitely polygenic (involving multiple genes),” van Weeren says.

In fact, genomic advances and molecular genetics “have only given further evidence of the complexity of the disease,” says McIlwraith, adding that osteochondrosis genes are present in at least 22 of the horse’s 33 chromosomes.

“Because of that complexity, it’s going to be difficult to ever breed it out,” he says. “And that effort might lead to inadvertently selecting out other desirable traits.”

Links to Feeding and Metabolism

Indeed, there’s such a thing as growing too fast, and it can open the door for osteochondrosis.

“A high plane of nutrition has been associated with thicker growth cartilage, which is more dependent than thin growth cartilage on blood supply for nutrition,” says Carlson.

Young horses eating high-energy meals grow faster, putting them at risk for osteochondrosis.

Photo: Anne M. Eberhardt/The Horse

Pauline Peugnet, PhD, of France’s Agricultural Research Institute (INRA), in Jouy-en-Josas, demonstrated the effects of accelerated growth in a recent study (see TheHorse.com/36719). She placed pony embryos in draft horse mares and found that, due to the “enhanced” gestational environment, the foals developed in the womb faster and were much bigger at birth than ponies born to pony mares. Interestingly, she notes, those pony-in-draft foals also had a much higher rate of osteochondral lesions.

What’s more, those same foals had a greater risk of developing osteochondrosis in the first six months of life as they nursed from draft mares producing more and possibly richer milk, Peugnet adds.

Environment Plays a Role

It’s case of damned if you do and damned if you don’t: A young foal living in a big field is probably more likely to injure himself than one confined to a stall. But confining a youngster only encourages osteochondrosis development. In a recent study INRA researcher Johanna Lepeule, MS, PhD, showed that foals (particularly those younger than two months) exercising freely in a moderately sized pasture every day developed significantly fewer osteochondral lesions by six months than foals kept in stalls.

To prevent these problems, she says, “they have to get outside and moving.”

Diagnosing Osteochondrosis

One of the most common ways veterinarians discover osteochondral lesions in mature horses is during prepurchase exams, says McIlwraith. That’s because most of these lesions don’t actually cause any clinical signs, so owners are probably unaware their horses even have them.

Young horses, however, often do show clinical signs, such as joint effusion (swelling) and lameness, that merit a work-up, including imaging, he says. These are often caught when young horses first start training, on radiographs of the effused joints. In-clinic radiographs are common, but some owners opt for a more thorough (and more expensive) MRI exam. A less expensive option is ultrasound, which van Weeren says is showing some good results in initial diagnostic studies.

A (Mostly) Self-Healing Disease

Most osteochondral lesions are nothing to worry about because they’ll heal on their own. Van Weeren says lesions diagnosed before a horse is a year old stand a good chance of improving. Carlson places the “age of no return” at 18 months for some fetlock lesions and for the stifle joint, areas where osteochondral lesions continue to evolve a bit longer, she says.

The researchers warn that location does make an important difference in outcome. Ostechondrosis in the femur (the long upper bone of the hind leg) seems to resolve well in nearly all cases. As for hock lesions, Denoix and co-authors on a study reported there was no clinical progression in 60% of cases. And fetlock lesions appeared just as likely to resolve as they would progress.

When Surgery Becomes Necessary

There are situations where OCD becomes problematic enough to warrant arthroscopic surgery to remove the lesion. McIlwraith says that’s usually because the horse will have permanent clinical problems (e.g., arthritis or lameness despite treatment) without surgery or because the high-value horse can’t be sold for a good price without correcting the lesion.

If a horse will have permanent problems due to an OCD lesion, the veterinarian will remove it via arthroscopic surgery.

Photo: Anne M. Eberhardt/The Horse

Again, lesion location can be the deciding factor. The hocks and fetlocks, for example, are sites that can benefit from surgery. Stifles are a common surgery site, as well, says McIlwraith.

Shoulder lesions, however, depend on the location within the joint. Select cases limited to the glenoid (socket) typically do not require surgery. If they involve the humeral head (the end of the humerus bone that articulates with the scapula), surgery is necessary; still, these operations only have a 50/50 success rate.

Sometimes, McIlwraith says, it’s a “question of your pocketbook,” because, again, it’s possible to just wait things out to see how they progress. Surgery can help improve performance, increase sale values (through clean X rays), and limit the onset of secondary (caused by another condition) osteoarthritis.

But if you choose not to operate, rarely is it a welfare concern. “The only time OCD would be a welfare issue is with certain shoulder lesions, or a severe OCD lesion in the stifle, which we see extremely rarely nowadays, now that people know how to feed their foals better,” McIlwraith says.

Keeping a Reasonable Outlook

Yes, OCD is serious in that it affects a significant number of horses, particularly Warmbloods and Thoroughbred and Standardbred racehorses. But all in all, we might actually be overdoing it when we worry too much about osteochondrosis in our young horses.

There’s no reason, for example, to routinely radiograph our youngsters to check on their osteochondrosis status, say our sources. “Due to the multiple predilection sites in horses and the fact that different sites are affected at times during development, it would not be reasonable or cost-effective to X ray horses at multiple time points,” Carlson says. “Additionally, we have no current therapies for the subclinical lesions (those that do not produce clinical signs) other than resting the affected joint, and this is not usually possible with horses,” because they’re usually standing and frequently moving.

That being said, there are situations when OCD causes enough pain that it becomes a real concern—again, depending on the lesion’s location. “Some OCD lesions in the stifle and shoulder in horses carry a guarded prognosis, and some of these horses have to be euthanized,” Carlson says.

Take-Home Message

Osteochondrosis is a common but often temporary disease of young horses’ joints. Some lesions come and go without any clinical signs, while others are accompanied by swelling and/or lameness. Surgery is usually pursued for those that don’t heal on their own. While there are some exceptions, horses with naturally or surgically resolved osteochondrosis frequently go on to lead healthy lives to their full athletic potential.

About the Author

Christa Lesté-Lasserre, MA

Christa Lesté-Lasserre is a freelance writer based in France. A native of Dallas, Texas, Lesté-Lasserre grew up riding Quarter Horses, Appaloosas, and Shetland Ponies. She holds a master’s degree in English, specializing in creative writing, from the University of Mississippi in Oxford and earned a bachelor’s in journalism and creative writing with a minor in sciences from Baylor University in Waco, Texas. She currently keeps her two Trakehners at home near Paris. Follow Lesté-Lasserre on Twitter @christalestelas.

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rigbygigby-blog · 8 years ago

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How Can A Man Tell If He Has Girl Or Boy Sperm?

I am here in this article to show you the right way to choose the appropriate gender of your unborn child. All you need is a good baby gender predictor and you are good to go. You might wonder if this is real, yes it is, it contains only natural baby gender prediction ways.

Starting with the fundamentals, you need to know what sperm is and its types. A boy is usually attached to Y chromosomes while the X chromosomes carry that of the girl. The main theory behind any baby gender test is to determine which one surpasses the other and gets to the right place at the right time. So, here are the things you need to take into consideration.

Now that you know, when trying to have a boy, it is important to adjust your body's pH alkaline, you should make a diet plan. There is a plenty of information on the internet which groceries are more alkaline than others. Just make some Google searches using keywords "alkaline foods", "high pH foods", or alike. You will find enough information to plan your diet properly.

The myth says, "If you're carrying your baby high, it's a girl. If you're carrying your baby low, it's a boy." You can predict the gender by looking at your belly. Through nine months pregnancy you must consider that if you carry down low your baby probably boy, meanwhile if you carry up high your baby will be a girl.

What makes it work? Tiny muscles in your finger tips are connected to the motor centers of the brain and it is these motor centers that are affected by unconscious thoughts. Your unconscious thoughts cause the tiny muscles in your fingers to react and thus move the pendulum. This is called the idiomatic response. The pendulum then becomes a direct link to your unconscious. And the unconscious is where thoughts and memories are stored that your conscious is unaware of. The pendulum is a means of connecting with those hidden truths and memories. You try...

Lastly, follow these two coordinates to the spot where they meet and intersect, and look for the corresponding box labeled "B" for boy, or "G" for girl.

In layman's terms, there are basically a boy sperm and a girl sperm, both behave differently. Girl sperms are hardy, but they are also slow. On the other hand, boy sperms are faster, yet they are also weaker. In conceiving a baby boy, the theory is to take advantage of the boy sperm's speed and its weakness.

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kristinsimmons · 5 years ago

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“When Blood Breaks Down”: It Can Break Your Heart

By CHADI NABHAN, MD, MBA, FACP

Chadi Nabhan (@chadinabhan) is a hematologist and oncologist in Chicago whose interests include lymphomas, healthcare delivery, strategy, and business of healthcare.

“When Blood Breaks Down”: It Can Break Your Heart published first on https://wittooth.tumblr.com/

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