#healthcare decisions

[dianasmobilenotary]

Health directives are essential legal documents that outline your medical care preferences if you cannot communicate your wishes. These documents can include advance directives, living wills, and healthcare powers of attorney. A mobile notary in Sonoma County, California, is a crucial step in ensuring that healthcare providers validate and recognize these directives.

[kids-worldfun]

Choosing a Pediatric ENT: Tips for Parents

A pediatric ENT is an extremely important healthcare professional, particularly for those with kids. This type of medical worker is a specialist in pediatric ear, nose, and throat conditions that afflict children. They are sometimes called pediatric otolaryngologists and they can help with anything ranging in severity from an earache to a tumor. The primary care provider for your child will…

[allcomforthospice]

Advance care planning is crucial for ensuring your healthcare wishes are respected, especially during palliative care in Santa Clarita, California. This proactive approach involves discussing and documenting your preferences for medical treatment in case you are unable to communicate them yourself. It’s about taking control of your future healthcare decisions and ensuring your values and wishes are known to your loved ones and healthcare providers.

[ivyelitecarellc]

Advance care planning is about addressing your healthcare preferences. It ensures that your medical treatments align with your values and beliefs. For example, you can express whether you prefer aggressive treatments or prioritize quality of life over prolonging it through medical interventions. This clarity helps healthcare providers deliver compassionate care that respects your wishes.

[visitingpractitionersandpcllc]

Life throws a lot our way, and sometimes, navigating healthcare decisions can feel overwhelming. This is especially true for those facing serious illnesses. Advance care planning (ACP) empowers you to take control and have a say in the kind of care you receive, improving your quality of life.

[livingwellnessblog]

How can we talk about herbal medicine: The “West is Right” Model  of Herbal Medicine 

Explore the rich landscape of herbal medicine and its efficacy, drawing from both traditional wisdom and modern research. Discover the intricate balance between cultural practices, scientific evidence, and safety considerations in herbal remedies. From th

How can we talk about herbal medicine: The “West is Right” Model  of Herbal Medicine  There is a wide range of herbal remedies that have been used for centuries and many have shown varying degrees of effectiveness for certain conditions. However, the documented herbal medicine, traditional medicine, efficacy of herbal remedies, West Is Right model, scientific evidence, placebo effect,…

[ecomehdi]

Unveiling the Truth: Breast Cancer Overdiagnosis Among Women Over

Understanding Breast Cancer Overdiagnosis: A Comprehensive Insight Breast cancer stands as a significant concern for women across all age groups, with increased prominence as women reach their 70s and beyond. Recent years have witnessed mounting evidence of breast cancer overdiagnosis within this demographic, sparking critical debates about the efficacy and appropriateness of screening…

[vyeoh]

(The Washington Post)

For those who don't know, the US Supreme Court just ruled that states are allowed to enforce trans healthcare for minors. Undoubtedly, this will trigger a wave of other states that either hope to pass or have already passed policies to do the same. This is going to kill children, and harm more in long-lasting ways.

So, how can you help?

FUCKING VOTE. I don't care if you don't like Biden, he's not the only one on the ballot. Vote representatives into your city council who will turn our city into a sanctuary city. Vote for governors and state reps who will, even if they don't pass new protections, oppose bans being pushed through. Chsllenge and kick out conservative incumbents who are banking on their races being obscure enough for people to not vote in.

Anyone telling you voting is useless is either lying to you or grossly uninformed and think saying this is the edgy new take that will make them look hip and informed. Yes, the system is broken. But short of burning the whole thing to the ground (which personally I'm not a fan of as I quite enjoy having like. Roads and the FDA) what we can do is to change it for the better, by starting with the local races and working our way up.

[reasonsforhope]

THANK FUCKING GOD

"The Supreme Court on Thursday [June 13, 2024] unanimously preserved access to a medication that was used in nearly two-thirds of all abortions in the U.S. last year, in the court’s first abortion decision since conservative justices overturned Roe v. Wade two years ago.

The nine justices ruled that abortion opponents lacked the legal right to sue over the federal Food and Drug Administration’s approval of the medication, mifepristone, and the FDA’s subsequent actions to ease access to it. The case had threatened to restrict access to mifepristone across the country, including in states where abortion remains legal.

Abortion is banned at all stages of pregnancy in 14 states, and after about six weeks of pregnancy in three others, often before women realize they’re pregnant.

Justice Brett Kavanaugh, who was part of the majority to overturn Roe, wrote for the court on Thursday that “federal courts are the wrong forum for addressing the plaintiffs’ concerns about FDA’s actions.”

The opinion underscored the stakes of the 2024 election and the possibility that an FDA commissioner appointed by Republican Donald Trump, if he wins the White House, could consider tightening access to mifepristone, including prohibiting sending it through the mail...

Kavanaugh’s opinion managed to unite a court deeply divided over abortion and many other divisive social issues by employing a minimalist approach that focused solely on the technical legal issue of standing and reached no judgment about the FDA’s actions...

While praising the decision, President Joe Biden signaled Democrats will continue to campaign heavily on abortion ahead of the November elections. “It does not change the fact that the right for a woman to get the treatment she needs is imperiled if not impossible in many states,” Biden said in a statement...

About two-thirds of U.S. adults oppose banning the use of mifepristone, or medication abortion, nationwide, according to a KFF poll conducted in February. About one-third would support a nationwide ban...

More than 6 million people [in the U.S.] have used mifepristone since 2000. Mifepristone blocks the hormone progesterone and primes the uterus to respond to the contraction-causing effect of a second drug, misoprostol. The two-drug regimen has been used to end a pregnancy through 10 weeks gestation...

Biden’s administration and drug manufacturers had warned that siding with abortion opponents in this case could [have] undermined the FDA’s drug approval process beyond the abortion context by inviting judges to second-guess the agency’s scientific judgments. The Democratic administration and New York-based Danco Laboratories, which makes mifepristone, argued that the drug is among the safest the FDA has ever approved."

-via AP, June 13, 2024

--

Note: A massive relief and a genuine victory - this will preserve access to the medication used in 2/3rds of abortions last year, for at least another 2 years. (Probably minimum time it will take Republicans to get their next attempt before the Supreme Court.)

Still, with this, a sword that has been hanging over our heads for the last two years is gone. There will be a new one soon, but we just bought ourselves probably at least 2 years. The fight isn't over, but this is absolutely worth celebrating.

[palatinewolfsblog]

"We should measure the prosperity of a nation not by the number of millionaires but by the absence of poverty, the prevalence of health, the efficiency of public schools, and the number of people who can and do read worthwhile books." W.E.B. Du Bois.

[sergle]

yall are about to piss me off by not having any PASSING basic knowledge of the way the u.s. military manipulates its recruits into joining by typing up one of your uninformed, unresearched, unempathetic, individualistic, unbelievably annoying posts about how 100% of the people in the military ended up there because they just Love America So Damn Much! they're extremely mature and informed at time of recruitment, they can totally leave anytime they want, they totally had tons of other avenues in life they could've taken, there was no rush at all to get income as fast as possible, and everyone in the military also totally is part of the combat divisions and personally enjoys being IN the military very much, big believers of violence. everyone in the military is shooting guns all day, that's how that works. they LOVE BLOODSHED. also I love the "amewicans haha" twang to this type of shit because you're actually TOTALLY stealing our Thing, which is turning systemic issues into Individual Issues. Instead of talking about the powers that be, it's so Personal Choice up in here. It's, "well you shouldn't have done it then. I totally wouldn't because I know better." you don't wanna talk about the military industrial complex as a whole, and you don't want to talk about recruiters, you just want to pin the blame on Specific Individual People one-by-one, as if they're responsible for the system that they're being ground up in. someone was in the military? bad person, no matter what. it's easier to believe that, I guess, than to acknowledge that Normal People (with high school educations) are manipulated and incentivized into joining a system that is Bad. at like age 18. but yeah no that 18 year old should have just been smarter lol haha anyway here are some screenshots for no particular reason

side note this reply of someone going "umm just get loans and go into a high paying field it's easy XD" as a direct response to someone trying to explain how most americans joining the military are being funneled in that direction out of a need for money.

and another person who Decided that americans join the military just CLENCHING their teeth thinking of other people, and not thinking completely selfishly about their own selves and their own income/housing/healthcare.

[midnightlovestories]

I, for one, love the fact the the writers in Prodigy made Janeway retire from Starfleet. Not only it makes sense but also shows her character growth.

Janeway loves Starfleet, Janeway IS Starfleet but I really appreciate that Prodigy showed that you can experience burnout even in doing something you love, in something that you considered part of who you were.

I love that Janeway allowed herself to recognize that it was becoming too much for her and took active steps to focus on herself (retirement). She's been through a lot even before Delta Quadrant and the PTSD from the Delta Quadrant alone was enough for her to spend the next decade in therapy. Also, if we consider Mosaic as canon for her backstory, she never really dealt with the loss of her father and fiancé, or her depression. She never grieved properly, she never processed her loss, she forced herself (and was pushed by her sister) to move on, she returned to Starfleet and kept herself busy, she buried her grief.

All that is a lot to carry and I mean A LOT. It all boils over in 'Night' in season 5 and she succumbs to her depression and then AGAIN, in the end she just claws her way back because the crew loves her and won't allow her to sacrifice herself and also her sense of responsibility to her crew wins. She claws her way back. She had a job to do, she has to get them home. Self-sacrifice is imbedded deeply in her character.

But there's no respite at home. Home is not the same.

Janeway is a scientist and an explorer first anf foremost, she’s also excellent diplomat. Politics is part of diplomacy but politics is not why she joined Starfleet for. Her job as an Admiral is now mainly politics, it's a chronically stressful occupation with insane responsibility and Janeway hadn't had a break for years at this point. And even Chakotay’s disappearance aside, she's clearly disillusioned with what Starfleet is at this point.

It is becoming too much and Janeway acknowledging that is huge step for this character, it must be nothing but devastating to acknowledge that the one thing you gave your life in service of, is no longer serving you, it's actually bad for you and your mental health. I don't believe Janeway took the decision to retire lightly, I imagine it broke her heart to retire but she needed it.

I know kiddies watching PRO won't know any of this, because you need to know Janeway’s backstory from Voy, but just the fact that the show for kids did not shy away from trauma and mental health issues is, in my opinion, phenomenal. I love and applaud the writers decision to make Janeway retire, however briefly. It checks out.

[fairuzfan]

Zionists/Symathizers who say "Palestinians should be taken by Egypt/Lebanon/Jordan and just live there forever" have no idea what a refugee camp is like.

[frances-baby-houseman]

Cecily Strong announced that she's pregnant today, thanks to IVF. I think about goober the clown all the time, and I hope (as does cecily) that every woman and clown has the ability to plan her own family the way that cecily and goober did.

[skyloftian-nutcase]

Provider Discretion (LU in Healthcare)

(Lots of technical jargon in this one, lovelies, hope you don’t mind)

Something wasn’t right.

The patient herself was… okay. Mostly. She had called 911 because she’d had back pain that had just been getting worse, and she’d said she couldn’t even get around anymore.

Mo and Hyrule often exchanged a somewhat exasperated look when someone called an emergency line for something that had been an ongoing problem, but today this… was different. She just didn’t look well.

“I’m really sorry,” the patient apologized for the fourth time as Hyrule and Mo loaded the stretcher into the ambulance.

“It’s okay,” Hyrule quickly reassured her. His heart ached a little at how much this woman wanted to seem to shrink into oblivion. Even Mo, who, despite his big heart, often came across a little standoffish, had tried to make her smile multiple times. “This is what we’re here for.”

With a chief complaint of back pain, there wasn’t much to do outside of check vital signs. Mo could easily take this call. But Hyrule just… this felt wrong.

“Let’s get a 12-lead,” he said, already grabbing the cables for it while Mo got vitals. His partner didn’t argue, helping him place the leads in the right positions.

Vitals looked mostly fine. The patient’s blood pressure was high. She said she had a history of hypertension, so perhaps between that and her pain that would explain it. Though 180/98 did not make Hyrule particularly happy. But he couldn’t treat that.

The 12-lead showed normal sinus rhythm. Nothing wrong there. But something just didn’t feel right.

Grabbing the blood pressure cuff, Hyrule checked it again, but on the opposite side.

There was a discrepancy.

Hyrule and Mo looked at each other, eyebrows pinching. Mo took a manual on the left. Hyrule took a manual on the right.

They still didn’t match.

Feeling dread fill him, Hyrule told Mo, “I’m taking this call. Let’s get going. We don’t need lights but… just drive expediently, ok?”

The transport was blessedly uneventful. But the discrepancy remained. Her blood pressure was high, but higher on one side than the other. Coupling that with back pain…

Her aorta. Hyrule was worried about her aorta. The biggest artery in this woman’s entire body could getting ready to tear apart.

When Hyrule texted Warriors later, he got his answer.

Dissection. They rushed her to the OR. You pointing out the BP difference really tipped off the doc. Good catch.

Mo whistled. “Good thing she didn’t rupture in our truck.”

Hyrule blew out a breath. He was just thankful he trusted his gut.

XXX

The dispatch information had been for diabetic emergency. Fire had gotten there first, which Aurora was thankful for since she and Dawn were coming from the hospital and therefore farther away than if they’d responded from the station.

When they arrived, the house was a nightmare. The street was so narrow that the ambulance and fire truck blocked the road entirely, the stairs were so narrow Aurora felt like she had to squeeze her arms in just to climb up them, and the turns were so sharp she wasn’t sure how any kind of equipment could get up there. The patient was lying on his bed, altered, and unable to move.

According to the patient’s friend, he’d heard him fall and came up to check on him. He knew he was a diabetic and figured his blood glucose had to be low. Fire had already checked it, saying it was over two hundred. As the firefighter paramedic gave information to Aurora, he said, “He could be acting like this because of his sugar. Could be a stroke. We’re not sure.”

Honestly, Aurora couldn’t see the patient all that well from her vantage point. Dawn had already walked in and started assessing, they’d handed a reeves stretcher to the firemen, and they were working on loading him on to it. The girl went downstairs to prep the stretcher for their arrival. Once they managed to get the patient into the ambulance, Aurora stared.

This man’s entire right side of his face was noticeably drooping. He was moving his head a little to the left, eyes somewhat moving, pupils equal. Aurora quickly asked him to look at her, to follow her finger. While he could stare at her, he couldn’t track at all, and his eyes wouldn’t move to the right. He blinked once while attempting, and was only able to blink his left eye.

Who the hell thought this could be his sugar??

Once Dawn got in the truck, they were quick to get vitals and a 12-lead. He was hypertensive, all other vitals fine.

“We need to stroke alert this,” Aurora immediately said.

“But he was last seen normal three hours ago,” Dawn said uncertainly. “Isn’t that outside the window? Or is the window four hours now?”

“I think it’s four,” Aurora answered. “And it doesn’t matter either way. This is absolutely a neuro issue. Drive us hot, okay?”

Dawn nodded, heading to the front. She drove to the hospital with the lights and sirens on, allowing them a faster transport time, while Aurora called it in to the hospital. As they progressed, she tried to get the patient to follow commands, but he couldn’t. He held up his right arm but couldn’t hold his left up at all, and he still didn’t really track any movement.

When they arrived at the hospital, they were placed in a major room, transferring him quickly to the hospital bed. Warriors was charge that night, working on coordinating all the help they’d need for this patient. The ED physician entered, looking the patient over, and then turned to Aurora, asking, “So what makes you think he’s having a stroke?”

Aurora stopped in mid motion, looking at him with the most enraged and bewildered expression. “I’m sorry, what?”

“Why do you think he’s having a stroke?” The doctor repeated.

“What makes you think he isn’t?!” Aurora snapped, completely mind blown that this was even a debate. “His face is drooping so low it’s hitting the earth’s fucking crust, he’s altered, not tracking movement, blinking with one eye, down on one side, is hypertensive, and you’re asking why I—do you even know what a stroke is??”

“Let’s just alert it,” Warriors said calmly as he walked into the room, clearly sensing that the paramedic was about to explode. “It’ll get us a CT to rule it out.”

Aurora was fuming, and she stormed out before she could hear a response. Dawn tried to gently check on her, only to be subjected to her ranting for the next hour.

Later, Warriors texted Hyrule, who relayed the message. “You were right.”

“OF FUCKING COURSE I WAS!”

XXX

Legend wasn’t particularly a fan of working triage.

There were aspects of it that were exciting - he was the one to make first contact with patients who didn’t come in via ambulance, and he determined their acuity. But there was also a public relations aspect to it, a patience dealing with impatient people, a kindness and sympathy for those who were genuinely hurting or needing help but had to wait anyway. It was understandable, but public relations… was not Legend’s forte.

There was a reason he was put in triage, though.

It wasn’t always obvious, what was wrong with someone. But there were times when a patient just didn’t look right. Legend saw the man limp over, listened to him as he explained that he had some leg pain that had been going on for the last few days, how he thought maybe he’d strained a muscle but the pain hadn’t improved.

There were always signs to look out for. Little things, cues that something was off. The man looked resigned, reluctant; he clearly had been talked in to coming to the hospital, and he commented that his wife insisted on it. Legend saw the clothes he wore, heard the accent he spoke with, saw his muscles, and pieced together that he was probably a farmer.

Farmers never came to the hospital.

“We’ll get you back as soon as we can,” he finally said after completing his assessment. Usually, this patient would be low on the acuity scale—a muscle spasm or strain was not nearly as important as a heart attack, pneumonia, sepsis, strokes, traumas—but Legend made him a yellow rather than a green. Just to be sure.

That higher acuity score got him a room far faster. That faster room made a doctor assess him and notice that his left leg was bigger than his right. That doctor made sure he got an ultrasound of his leg, found clots in his leg. She also learned the man was short of breath sometimes, which his wife insisted was new, and got a CT scan.

Legend glanced at his chart later to see him being admitted. Confused and curious, he did some digging.

The man had a pulmonary embolism.

Huffing with a small smile of satisfaction, Legend closed out of the chart as another patient approached.

XXX

Time had to admit, he did not spend as much time assessing his patients as he should. His hours were stolen away in the OR, unpredictable and chaotic as his line of work was. So sometimes he didn’t get to round, sometimes he didn’t have a chance to walk in and chat with the patients and the nurses and the licensed independent providers who took charge of their care.

Today he was glad he did.

The patient was actually calm and pleasant, had little complaint of anything except for some lower back pain. In the world of uncomfortable hospital beds, it wasn’t a huge surprise.

But Time saw something. Some staining, bruising, around the patient’s groin. He peeked around their gown, turned them a little, and saw it.

Their groin was purple. He asked the nurse, who said they were told this had been baseline for a day or two, and that the independent providers over them had acknowledged the finding and moved on.

Time walked into the doc box where the providers were. “I want a CT abdomen for room 3. She’s got some bruising that’s concerning. Her H&H has been down trending steadily.”

“Her JP drains haven’t put out much,” the physician assistant noted, looking over the patient’s chart.

“She might have a retroperitoneal bleed,” Time pointed out. “Let’s just be sure.”

Years of education and even more years of experience had taught the trauma surgeon well. The war was especially humbling and educational. So when he got a text from the PA that the patient did indeed have a retroperitoneal, he wasn’t surprised. But he was disappointed that he had to be the one to notice it.

Sometimes, he supposed, it took the leader to point out the problem.

XXX

Four… didn’t like this.

Report had been bad enough. The day shift nurse spoke of how the patient had been previously septic and was recuperating well before her pressor demand had gone up during the day. She looked… not great. She was so edematous they were constantly changing the sheets underneath her arms because her body was leaking fluid from every inch of itself - they had dumped fluids into her over the last few days just to maintain her blood pressure. She was on a lasix drip to get her lot o pee off the fluid as best as possible, and her kidney function was… decent, but not great.

As Four assessed her, the clenching his chest only worsened. She was alert, oriented, a little miserable but trying to be in good spirits, bless her. She was peeing a decent amount, her pulses were present despite the swelling, her lung sounds were a little coarse but overall mostly clear. Her abdomen was soft and non-tender, her pupils were equal and reactive, and she didn’t have much complaint of pain aside from being sick of laying in bed, which Four could understand.

But still. This just… didn’t look great.

As the night progressed, the woman’s pressor need climbed. Four continued to increase epinephrine, increase norepinephrine. He tried not to increase the vasopressin too much as it had such a profound effect on vasoconstriction that it could cause necrosis. Also, the woman had a history of heart failure and had a pretty weak heart.

Four eventually went to the resident in charge of the patient for the night. “Hey. Can we maybe give 11 some albumin? She has plenty of fluid to give, but clearly it isn’t in her vasculature - she’s peeing ok but her pressure isn’t tolerating it. I feel like it could help.”

The resident shuffled on his feet uncertainly. “The surgeon really wants to make sure we can get this fluid off. I’d rather keep her negative and not give her more fluid, you know?”

“Yeah, I get that,” Four greed before continuing, “But albumin is only 250mL, and if it helps suck in the fluid that’s third spacing, it’ll still help. We’re dumping fluid in her through the pressors anyway.”

The resident continued to waffle, before the night attending asked, “She’s on vaso, right?”

“Yes.”

“Just go up on that.”

Four stared a moment longer, starting to doubt himself. He hadn’t been a nurse for long, and if an attending physician was saying this, then… it had to be true, right?

Sighing, he went back to the room and did as he was told. The patient’s blood pressure improved well enough, and the night progressed fine.

The next night was not as fine. At rounds, Four suggested that perhaps she should be lined for CRRT, a continuous dialysis that would allow for Four to control how much fluid they were pulling and would likely be better for the patient to tolerate. The night doctors shrugged, saying they’d mention it to the day team.

Again, the woman’s blood pressure was tanking. Again, Four had to increase pressors. Vaso had been turned down and was told to be left alone because the woman’s systemic vascular resistance was so high the attending was worried about her heart. (Four couldn’t help but feel a little bitter about it, because he knew that was going to happen)

This time, though, she went into atrial fibrillation as well. As Four called the resident and attending into the room, they deliberated the matter, muttering, “Maybe we should line her for CRRT.”

Four blinked. Stared. Was he… losing his mind?? Was he invisible? He’d suggested this earlier!

Ultimately, Four had managed to keep the patient stable enough so that it wasn’t needed. Ultimately, the shift ended uneventfully.

But when Four came back for his third night, he could hear the woman’s breathing from the door, he could hear how she was drowning in fluid because she couldn’t tolerate losing fluid but had too much for her lungs and heart to handle. The day team had lined her for CRRT, but her pressors were almost maxed out at their dosage, and she was so hypotensive that the renal nurse who had set up the machine was hesitant to start it up, saying it would further bottom out her pressure.

Tonight was different, though. Tonight, the provider in charge of making decisions and orders was a nurse practitioner, someone who was used to this unit. She walked in, saw the issues Four had seen, and she walked right back out, making a call.

Four struggled to keep the patient alive long enough for the ECMO team to arrive as the patient fell apart. He felt frustration boil his blood as he had to hand off her care after fighting for her, had to watch as the CV ICU nurse came in to take over while surgeons put large cannulas into the patient’s body to redirect blood flow around her heart so she could still perfuse her organs. He watched as they wheeled her out of the trauma ICU to go to the cardiac ICU where she would remain while on such extreme support, and he threw his pen on the desk, burying his face in his hands, fuming.

They should have listened to him.