#sleep apnea consultation

[harmeet-saggi]

The Impact Of Sleep On Heart Health: How Getting Enough Rest Can Save Your Heart

Have you ever wondered how your sleep habits might be affecting your heart health? In a world that never seems to stop, the importance of sleep often takes a backseat. But what if I told you that getting enough rest can actually save your heart? This blog explores the intricate relationship between sleep and heart health, shedding light on how prioritizing your slumber can be a game-changer for your cardiovascular well-being. So, let's dive in and uncover the secrets of the remarkable connection between a good night's sleep and a healthy heart.

[damnfandomproblems]

763632033850327040

TW.

I know I'm going off on a tangent here, but I want to say that people using the term "mouth breather" is always really disheartening. It's a huge gut-punch in a situation many people have been dealing with for decades.

Here's my deal: I've had sleep-disordered breathing since I was a kid. It started with bad nasal resistance issues, which meant I I couldn't breathe through my nose and had to use my mouth. Parents didn't do jack shit about it because they didn't know it was a big problem. And it totally messed up the formation of my skull. Now my jaw is slightly recessed, I have vertical maxillary excess, I can't fully close my lips, and my airway looks like a coffee straw (I've seen an MRI of this and it's totally pinched when I'm on my back, and even when I'm upright), so I can't even breathe through my mouth properly without a ton of noise and resistance. Every day, I wake up with a sore throat, dry mouth, and feeling like death. That "mouth breathing" has given me sleep apnea and UARS. CPAP doesn't help so I'm looking at a bilevel now and failing that, ASV. My jaw joint sounds like gravel and constantly clicks out of place.

And doctors don't do shit. I've seen three different ENTs for my nasal issues, and all three of them just scoped my nose and said "idk, looks fine". None of them actually looked at the skeletal structure of my face despite being fucking ENTs who are supposed to, you know, know everything about the nose. None of them actually thought, huh, I'm using the pediadric scope for your nose, that might indicate there is a bigger fucking problem than just your turbinates, which you've already had a reduction for. Nope. Nothing.

The one jaw surgeon I went to told me, "idk, I can give you a sliding genio, but that's it, I don't want to mess up your ~pretty face~ (yerk) by doing an advancement". When I literally need an advancement of some kind because my jaw and tongue is encroaching on my fucking throat.

Meanwhile, I've been suffering for 20 years thinking I had treatment resistant depression and insomnia when in reality, it was my shitty breathing and every day, currently stuck with a CPAP, I look at my data and breathing waveforms and I observe they look like they've been shot with buckshot. All my breaths are flat or ragged. I see myself constantly gasping because I can't get enough air. My DME (CPAP) provider won't even look at that data, because all they want to look at is a shitty single number that isn't even accurate, because CPAP machines are garbage with actually detecting breathing issues so they constantly spit out lower-than-reality numbers, especially for people with UARS.

Now I'm looking into double jaw surgery and EASE, and the initial consultations for each are months away. I can't do anything in the meanwhile. And the real fuck-shit part of this? I live in a country with "free healthcare", but the doctors can't even solve this. And the system moves way too fucking slowly. Twenty years of languishing, only to be told over and over "you must be a hypochondriac, it's just depression, we don't need to look at the data"? Fuck that. So I'm going to go into debt paying nearly 200k for double jaw surgery and for nasal expansion. I've considered killing myself over this plenty of times. I can't imagine how many people have killed themselves over this. All because they can't breathe through their nose.

From the bottom of my heart, fuck anyone who uses the word "mouth breather" like it's a fucking joke or an insult. Fuck them.

Sorry, I saw an opportunity to vent and took it.

Posting as a response to a previous ask.

[dustmint]

Lodgetember Day 3: Headcanons!!!

Here are some flowers headcanons because she's my favourite

She's one one of the newer lodgers and joined maybe one month or so before Jasper did

She's not a talkative person, but she is one of the more gossip-y lodgers, she's used her spy bugs to see what's going on at the society sometimes and to get a bunch of gossip

Jekyll caught her doing that and told her not to, still does it sometimes

She keeps live bugs in her lab to study, they're kinda like her pets and she has names for all of them

She likes to draw, has a preference for drawing her bugs or real people that she knows or remembers meeting, she's drawn some of the lodgers and is on a quest to draw them all (if she gets the courage to ask)

She keeps a diary that's not really up to date, but she has written down random information like reminders, the name of the other lodgers and what they do, as well as which lodgers are scared of bugs and those that aren't

Very good listener, will remember weirdly specific details but will walk into a room and forget why she was there

Used to have a big fear of bugs until she became obsessed with them one day, still kinda has a fear of some of them

Likes to fiddle with her spy bugs sometimes and say stuff to them

First met Jekyll after some of her spy bugs went haywire and started flying around everywhere, copying a bunch of noise and terrorizing some of the people around the area where she lived, that Jekyll happened to be passing by. He was able to use the bugs to track her down, and he offered to help with the ones that were malfunctioning. The bugs caused a small-ish scandal but no one knows it was her except for the rest of the lodgers, Rachel and Jekyll (But the police never found her and probably never will)

Keeps both real and robot bugs locked away very securely inside her lab

Had a habit of picking at her nails, main reason for wearing gloves

Has insomnia and sleep apnea, so she has a lot of trouble sleeping. Most nights she won't even bother trying to sleep and will just fiddle with some of her mechanic bugs instead, but she'll usually end up falling asleep in the middle of working

Very good friends with Bird, I like to think they've went to the countryside or somewhere like that to go catch bugs to look at and also to look for rare plants

Also good friends with Lavender, no reason why, I just think they would be good friends

Consulted Maijabi and Tanis about if bugs has souls and if a bug died if they could bring it back, Maijabi did not answer the question. But she and Tanis keep randomly having very serious discussions about it and also about if it would be possible to put the soul of a bug into one of her spy bugs. This ended up with them becoming friends

Hangs out a lot with Pennebrygg to talk about automatons

Has considered making automaton bugs to murder someone, hasn't gotten around to actually doing it

She's aromantic

[clown-demon]

((My body has been going through worse and worse pain... Like it's just, been getting worse. Today at work my ankle hurt so bad I couldn't walk on it and I had to sit down for a bit.

I can't go to sleep atm cuz my body hurts too much.

I've been to the doctors three times for this. First time they didn't even run all the tests it could be. Second time they did and found nothing. Third time the doctor just latched onto me saying I am tired when I wake up and wrote off my body pain as sleep apnea, and I won't be seen for a simple consultation until February.

I'm frustrated cuz it costs me a money to keep seeing these morons and they're just like 'well your blood tests came back normal. So you're fine.' Also my urine test got contaminated, but they ran it thru tests-- and it's fine too. No kidney infection.

So I just... get no help... I get told 'you're fine cuz your tests came back normal.' Even though I am going thru so much pain. I pay them money, for them to tell me it's nothing.

[gaynfl]

Can you talk about how you got diagnosed with sleep apnea? I think I have sleep apnea, but my consult with sleep medicine isn’t until January

hey there, I would LOVE to talk about this

so the main "symptoms" of sleep apnea are waking up exhausted, waking up with a headache or dry mouth, daytime sleepiness, falling asleep sitting up, and pretty much anything you associate with being sleepy (mood swings, irritability, difficulty focusing or learning new things, etc...) so even before I shared a bed most nights with my then girlfriend (now wife), I knew something was wrong because man... I was tired all the time. I would fall asleep at work sitting up. I wouldn't be able to get out of bed all weekend because my body was so tired. I would barely be able to wake up for work, I had to keep cold water next to my bed to wake myself up. I had headaches all the fuckin time. I thought it was just fatigue (because I had experienced intense fatigue after my sisters death and it felt like it just didn't go away, yk? Wrong!!)

But I finally went and talked to my doctor about all of these things after my mom and wife were like "this is sleep apnea" and I told my doctor all of the struggles I was having (especially daytime sleepiness, I would almost fall asleep driving) and my doctor got me a sleep study referral like as soon as I said I was falling asleep sitting up.

I had an at home study with the whole set up, which was wild to set up and everything. Sleeping was Very Hard with all of that attached to me and I kinda wish I had pushed for an in person one but it was COVID so I took what I got! The at home test includes oxygen monitoring, a cannula to monitor your breathing, heart monitors and position equipment to see how you're sleeping when you have an apnea. It's all attached to your chest with this box that keeps all of the info for the doctors to look at later, it was actually pretty cool.

My sleep study results... ouch. So they average out your apneas per hour as well as your average oxygen levels per hour. But they'll also tell you your oxygen high and oxygen low. My high was like 89 and my low was 48 if I remember correctly. My average sleep apnea's per hour was 117, which means about two a minute! Horrible stuff!! Explains a LOT. And as soon as they sent me my results, they were getting me a machine. I think I had my test on like January 18th and by the 31st I had my CPAP.

now, if you get a CPAP please for the love of god use it. the difference in me as a person were night and day. the first weekend after only using it for Thursday and Friday nights was a whole new world. I was awake all day, didn't have to lay down to take long ass naps, and the first day I woke up I had deep indents from the mask but I felt SO good

so, long story short - if you think there's something wrong with your sleep, there probably is and a sleep study will help figure out what. I hope you're able to get answers and some rest soon!!

[melamedcbd]

The Ultimate Guide to Sleep Help: Tips and Techniques

Introduction:

Sleep is essential for overall health and well-being, yet many people struggle to get the rest they need. Whether you have trouble falling asleep, staying asleep, or waking up feeling refreshed, this ultimate guide to sleep help will provide you with tips and techniques to improve your sleep quality and overall health.

Understanding the Importance of Sleep:

Before we dive into tips and techniques for better sleep, let's first understand why sleep is so important. Sleep plays a crucial role in various aspects of our health, including:

- Physical health: Sleep helps repair and rejuvenate the body, supporting healthy growth and development.

- Mental health: Adequate sleep is essential for cognitive functions such as memory, concentration, and decision-making.

- Emotional well-being: Sleep influences mood and emotional regulation, helping us cope with stress and challenges.

Common Sleep Disorders:

Before addressing sleep issues, it's crucial to recognize common sleep disorders that may be affecting your rest:

- Insomnia: Difficulty falling asleep or staying asleep.

- Sleep apnea: Breathing pauses during sleep, often accompanied by loud snoring.

- Restless legs syndrome (RLS): Uncomfortable sensations in the legs, leading to an urge to move them.

- Narcolepsy: Excessive daytime sleepiness and sudden sleep attacks.

Tips for Better Sleep:

Now, let's explore some tips and techniques to improve your sleep quality:

1. Stick to a sleep schedule: Go to bed and wake up at the same time every day, even on weekends.

2. Create a bedtime routine: Establish calming activities before bed, such as reading or taking a warm bath.

3. Create a sleep-conducive environment: Keep your bedroom dark, quiet, and cool.

4. Limit screen time: Avoid screens (phones, tablets, computers) at least an hour before bed.

5. Watch your diet: Avoid heavy meals, caffeine, and alcohol close to bedtime.

6. Stay active: Regular physical activity can improve sleep quality.

7. Manage stress: Practice relaxation techniques, such as meditation or deep breathing, before bed.

8. Seek professional help: If you have persistent sleep problems, consult a healthcare provider for further evaluation and treatment options.

Conclusion:

Improving your sleep quality is essential for your overall health and well-being. By following these tips and techniques, you can enhance your sleep hygiene and enjoy better rest. Remember, everyone's sleep needs are different, so it may take some time to find what works best for you. Prioritize your sleep, and you'll reap the benefits of a well-rested body and mind.

[speechandot]

SLEEP DISORDERS AND BEHAVIORAL ISSUES

Children facing sleep disorders may experience issues such as learning impairments and behavioral problems. It is crucial to address sleep disorders in children promptly to manage the condition and prevent potential harm to their development. At Speech and Occupational Therapy of North Texas, our trained staff can diagnose and treat various sleep disorders in children.

Obstructive Sleep Apnea (OSA): OSA occurs when a child’s airways are blocked or restricted during sleep. Enlarged tonsils, excessive soft tissue near the airways, obesity, or distortions in airway size can contribute to OSA. Roughly 5% of children may be affected by OSA.

Parasomnias: Parasomnias encompass behaviorally based sleep disorders like sleepwalking, nightmares, and sleep-talking. About 50% of children experience some form of parasomnia, influenced by genetics and aggravated by lack of sleep.

Behavioral Insomnia: Behavioral insomnia is an acquired inability to fall or stay asleep, affecting up to 30% of children. Sleep-onset insomnia occurs when a child refuses to sleep until a demand is met while limit-setting insomnia results from parents not setting or enforcing sleep-related rules.

Delayed Sleep Phase Disorder: This disorder occurs when children’s circadian clocks are offset by external stimuli, most commonly light exposure. Factors like body temperature, meal timing, and physical activity can also disrupt sleep schedules.

Restless Leg Syndrome: Children with restless leg syndrome experience an uncomfortable urge to move their legs due to discomfort or pain. Hyperactivity, iron deficiency, and genetics can trigger this syndrome. Diagnosis can be challenging, and while there’s no cure, treatment plans are available to alleviate symptoms.

If you need assistance in treating your child’s sleep disorders, please contact us at Speech and Occupational Therapy of North Texas to schedule a consultation and establish a tailored treatment plan for your child.

[dentistatplumcreek]

Tips for Maintaining Oral Health Between Dental Visits

Life whisks us away, and dental appointments often fall victim to the whirlwind. But fear not, fellow smile advocates! Maintaining excellent oral health doesn't require a calendar synced with your dentist's. By incorporating simple yet effective habits into your daily routine, you can bridge the gap between appointments and strut into your next checkup with pearly whites beaming with pride.

Brushing Bonanza: The Twice-Daily Ritual

Think of brushing as a superhero duo: fluoride toothpaste and a soft-bristled brush team up to vanquish plaque and bacteria, the arch-enemies of healthy teeth and gums. Aim for two minutes of vigorous brushing, morning and night, focusing on all tooth surfaces, the gum line, and even that sneaky tongue that harbors pesky bacteria. Remember, brushing too aggressively can damage your gums, so be gentle yet thorough.

Flossing Force: Battling the Plaque Between

Brushing can only reach so far. Enter the floss, your trusty interdental warrior. Once a day, weave that magical thread between your teeth, scraping away plaque and food debris that your toothbrush can't reach. Don't be afraid to hug the curves of your teeth—a gentle yet firm approach is key. And if traditional floss feels like a tangled mess, consider floss picks or water flossers for an easier, no-less-effective clean.

Hydration Hero: The Power of H2O

Water isn't just your body's best friend; it's your mouth's superhero in disguise. Sipping throughout the day washes away food particles and plaque, keeps your mouth moist (dry mouth is a breeding ground for bacteria), and even strengthens your tooth enamel. So ditch the sugary sodas and embrace the power of plain old water—your smile will thank you.

Dietary Defender: Choosing Smile-Friendly Foods

What you eat plays a major role in your oral health. Sugary treats and acidic foods create a feast for cavity-causing bacteria, while crunchy fruits and vegetables act like natural toothbrushes, stimulating saliva production and helping scrub away plaque. Choose wisely, and remember, moderation is key even for healthy foods.

Sweet Dreams for Your Smile: The Nighttime Routine

While you slumber, your mouth doesn't stop working. Saliva naturally bathes your teeth, neutralizing harmful acids and fighting bacteria. But if you have sleep apnea or snore, your mouth might dry out, creating a breeding ground for bad breath and cavities. If you suspect sleep issues, consult your doctor or dentist. They might recommend a special mouthguard or other solutions to keep your smile protected while you catch some Zzz's.

Bonus Tip: Embrace the Power of Prevention

Regular dental checkups and cleanings are like Kryptonite to oral health woes. Your dentist can spot potential problems early, offer targeted solutions, and keep your smile shining bright. So, schedule your appointments diligently and don't hesitate to reach out if you experience any dental concerns between visits.

Remember, a healthy smile isn't just about aesthetics; it's a gateway to overall well-being. By incorporating these simple tips into your daily routine, you can maintain exceptional oral health between dental visits, paving the way for a lifetime of confident smiles. And if you're ever in doubt, seeking guidance from a trusted Dentist in Kyle is always the best course of action. They'll be your partner in crime-fighting against dental woes, ensuring your smile remains a beacon of radiant health.

So, brush, floss, hydrate, and choose smile-friendly foods. Your commitment to these simple habits will empower you to conquer the gap between dental visits and reveal a smile that's not just healthy, but truly dazzling.

[mariacallous]

When smoke from eastern Canadian wildfires smothered much of Canada and the American East Coast this summer, it resurfaced a distant memory for Gus Sentementes. The last time smoke descended on his home in Baltimore, Maryland, was in 2002, when fires in Quebec spread smoke more than 700 miles southward.

But this summer was different. The smoke lingered longer and spread farther. It also created quite a stir in areas that aren’t used to being that close to the effects of a cataclysmic wildfire. The world is warming, extreme heat is spawning hellish blazes, and even those not in the immediate vicinity are feeling their effects far downwind. Sentementes felt like this wasn’t just a fluke—something that affected his life every 20 years or so. This felt like something that would likely happen again, and soon.

Like anyone who breathes (i.e., everybody), air quality always felt somewhat important to Sentementes. He has three kids, one of whom has asthma. Sentementes himself uses a sleep apnea machine at night. When the sky turned orange and taking a breath felt like sucking in a campfire, Sentementes decided it was time to learn more about how his air quality was changing. He bought a PurpleAir sensor that lets him monitor the air quality outside his house in real time and share the data on the internet, where it gets pooled with other sensor readings from down the street, across town, and around the world.

“It’s been an eye-opening experience, the last several months, just coming to understand the basic, most fundamental importance of clean air,” Sentementes says. "We just really don’t appreciate it until you’re forced to breathe in a lot of terrible air.”

Wildfire smoke has long been a staple of the summer months along the West Coast of the US. Earlier this summer, when the wildfires in eastern Canada burned thousands of acres and covered the east coast in clouds of acrid haze, people who had never known life in wildfire country found themselves choking on wildfire smoke. As wildfires worsen and spread, people in communities that aren’t historically thought of as wildfire prone are starting to track the smoke in their air.

“With all that's going on with climate change and all the extremes that everybody's experiencing, sadly, I think this is going to become the new normal,” says James Knox, who lives near Ottawa, Ontario, Canada. “We're going to have to start living with this.”

Knox recently bought two PurpleAir sensors after this summer's wildfires. He placed one in his yard at his home and the other at a family cottage a few miles away. Knox has consulted for public health agencies about Covid-19 and other infectious diseases. Being forced indoors due to the Canadian wildfires evoked the lockdown days of the Covid pandemic, albeit with its own twists. Back then, the guidance for social distancing allowed for outdoor excursions, like going for a walk. For someone like Knox, it was a way to stave off cabin fever and get some fresh air. But when the smoke came, he felt pinned inside without respite.

“We've been kind of conditioned to going out in fresh air, but that's dangerous now,” Knox says. "It’s a weird feeling.”

It’s relatively easy to check your community’s air quality. At least, if you live in the US, and also in an urban area that’s mandated to report such data to the Environmental Protection Agency. The Air Quality Index, or AQI, is the measure of potentially harmful particulate matter in the air around us. That includes everything from floating particles smaller than 10 micrometers (PM10) like dust and wildfire smoke to particles 2.5 micrometers (PM2.5) or smaller, like gas fumes. Official sources like the World Health Organization and the US-focused AirNow track air quality, usually more rigorously in populated areas, and rank the ratings on a scale from Good to Hazardous.

AQI readings have traditionally been taken by big, pricey measuring instruments owned and operated by state or local governments. But over roughly the past half decade, small, low-cost devices have democratized air quality monitoring. Companies like Purple Air and IQ Air have built up reliable air quality tracking networks made up by citizen-owned monitors; PurpleAir says it has more than 25,000 units in its network worldwide. These monitors are cheap devices that hook up to your Wi-Fi network and are easy to install. The sensors take regular air quality readings and then upload the data to the broader networks, offering a crowdsourced snapshot of air quality information that spans the globe. The devices aren’t perfect—there’s a greater chance of human error when the monitors aren’t placed by someone who’s trained to collect air quality readings—but the sheer scale of the network means inaccurate outliers have a higher chance of being drowned out by the sea of other nearby devices.

A platform like PurpleAir also makes the data immediately accessible by visualizing the air quality readings on a map, using a color-coded scale from blue and green (OK) to red and purple (very bad). Even if you don’t fully grasp particulate matter ratings, seeing a big red blob on a map over your house is a pretty quick way to tell something is off.

“It’s a form of engaged learning,” says William Mills, an exposure assessment researcher at Northern Illinois University. “You can touch it, you can feel it, you can see it. It’s community sharing that’s just easy for people to opt in to. You can gain as much or as little information as you want. Can we use that to look at other forms of environmental quality? Can we use it to help change behaviors?”

Making the data more accessible can make people more interested in paying attention to it, especially when disaster strikes. Elizabeth Spike is an alternative school teacher and the education program manager at Clean Air Partners, an advocacy group for air quality awareness based in Washington, DC.

“Between the wildfires and Covid, I think more and more people want to know what they are breathing,” Spike says. “It's terrible that it takes these tragedies, these crises to make us realize we've been sleeping at the wheel. We have no choice but to breathe, and yet we really haven't made a big deal about what we are breathing.”

Ammar Rai is a software engineer in Maryland. He’s had asthma since childhood, which was only exacerbated by a bout of Covid two years ago. When the wildfire smoke descended this summer, he wore a painters mask with built-in ventilators when going outside. Rai says he often feels like people with conditions like his are treated as a burden, until something like the summer’s wildfires brings widespread attention to air quality.

“People like me are like the canaries in the coal mines,” Rai says. “The stuff that we’re oftentimes reacting to is bad for you anyways. Somebody who may be perfectly fine and not show any apparent symptoms, they're getting exposed to this stuff too. Then many years down the line, you find out they’re impacted by it, or it's in their bloodstream, or they have some kind of lung disease.”

Indoors, his home is a veritable air quality fortress. He has four air purifiers in the house. He has phones mounted to a wall in each room of his house that let him see air conditions at a glance. They’re always on, and their interfaces evoke the multicolored blinking lights of the inside of a Star Wars spaceship.

He’s made his software dashboard for mobile devices available on Github, along with self-made data visualizers others can use to make sense of their Purple Air readings. Rai has a PurpleAir monitor of his own that he says nearly 500 people on the platform have favored as a resource in the area.

“It feels good to be able to provide this data to the community in some way and raise awareness,” Rai says. “My standards are probably different than other people's, but if it helps someone have a good day outside, hey, that's great. Wonderful.”

James Knox, in Canada, also hopes sharing his data will help researchers and forecasters looking to predict unhealthy air events in the future.

“I feel fortunate I'm in a position to be able to do this,” Knox says. “I can provide that information, and people can make use of it to inform their lives. It gives them better situational awareness. People are nervous. People are worried. This helps.”

Gus Sentementes says there’s a sort of camaraderie to it too. It's a spirit, he says, that feels like it has been squeezed out of much of the wider internet by a handful of big social media companies intent on monetizing their platforms at all costs and erecting walled gardens around their services.

“One of the gee-whiz wonders of the internet of the early days was this feeling of being connected to other people,” Sentementes says. “It’s community driven, community sourcing. There’s this sense of a collective project you want to contribute to. You’re not just taking from it, you’re giving something back.”

[mcatmemoranda]

Patient is a [ ] yo male/female presenting to the clinic for a preoperative evaluation.

Procedure [ ]

Scheduled date of procedure [ ]

Surgeon performing procedure requesting consultation for preop is [ ] and can be contacted at [ ]

This patient is/is not medically optimized for the planned surgery, see below for details.

EKG collected in office, interpreted personally and under the direct supervision of attending physician as follows- sinus rate and rhythm, no evidence of ischemia or ST abnormalities, no blocks, normal QTc interval.

The following labs are to be completed prior to surgery, and will be evaluated upon completion. Procedure is to be performed as scheduled barring any extraordinary laboratory derangements of concern.

Current medication list has been thoroughly reviewed and should not interfere with surgery as written.

Patient has no prior history of adverse reactions to anesthesia, problems with airway management, difficult IV access, prolonged emergence, or postoperative nausea/vomiting.

Airway Mallampati score: This patient is a Grade based on the criteria listed below

-Grade I Tonsillar pillars, soft palate, entire uvula

-Grade II Tonsillar pillars, soft palate, part of uvula

-Grade III Soft palate, base of uvula

-Grade IV Hard palate only, no uvula visualized

Patient is a low/medium/high risk for this low/medium/high risk surgical procedure.

Will send documentation of this preoperative visit to surgeon [ ].

**** ADDITIONAL INFORMATION****

Patient Risk for Elective Surgical Procedure as Determined with the Criteria Below:

1- Very Low Risk

No known medical problems

2- Low Risk

Hypertension

Hyperlipidemia

Asthma

Other chronic, stable medical condition without significant functional impairment

3- Intermediate Risk

Age 70 or older

Non-insulin dependent diabetes

History of treated, stable CAD

Morbid obesity (BMI > 30)

Anemia (hemoglobin < 10)

Mild renal insufficiency

4- High Risk

-Chronic CHF

-Insulin-dependent diabetes mellitus

-Renal insufficiency: creatinine > 2

-Moderate COPD: FEV1 50% to 70%

-Obstructive sleep apnea

-History of stroke or TIA

-Known diagnosis of dementia

-Chronic pain syndrome

5- Very High Risk

-Unstable or severe cardiac disease

-Severe COPD: FEV1 < 50% predicted

-Use of home oxygen

-Pulmonary hypertension

-Severe liver disease

-Severe frailty; physical incapacitation

Surgical Risk Score Determined as Below:

1- Very Low Risk

Procedures that usually require only minimal or moderate sedation and have few physiologic effects

-Eye surgery

-GI endoscopy (without stents)

-Dental procedures

2- Low Risk

Procedures associated with minimal physiologic effect

-Hernia repair

-ENT procedures without planned flap or neck dissection

-Diagnostic cardiac catheterization

-Interventional radiology

-GI endoscopy with stent placement

-Cystoscopy

3- Intermediate Risk

Procedures associated with moderate changes in hemodynamics, risk of blood loss

-Intracranial and spine surgery

-Gynecologic and urologic surgery

-Intra-abdominal surgery without bowel resection

-Intra-thoracic surgery without lung resection

-Cardiac catheterization procedures including electrophysiology studies, ablations, AICD, pacemaker

4- High Risk

Procedures with possible significant effect on hemodynamics, blood loss

-Colorectal surgery with bowel resection

-Kidney transplant

-Major joint replacement (shoulder, knee, and hip)

-Open radical prostatectomy, cystectomy

-Major oncologic general surgery or gynecologic surgery

-Major oncologic head and neck surgery

5- Very High Risk

Procedures with major impact on hemodynamics, fluid shifts, possible major blood loss:

-Aortic surgery

-Cardiac surgery

-Intra-thoracic procedures with lung resection

-Major transplant surgery (heart, lung, liver)

High risk surgery: yes/no

Hx of ischemic heart disease: y/n

Hx of CHF: y/n

Hx of CVA/TIA: y/n

Pre-op tx with insulin: y/n

DM/how are blood sugars?

Pre-op Cr >2mg: y/n

OTHER EVALUATIONS BASED OFF PATIENT HISTORY SEE BELOW:

1. CARDIAC EVALUATION

A. Ischemic Cardiac Risk- Describe any history of cardiovascular disease and list the cardiologist/electrophysiologist. For CAD, report the results of the most recent stress test or cardiac cath, type of procedures or type of stents, date of MI, and recommendations for perioperative management. Include antiplatelet management. Continue baby aspirin for patients with cardiac stents - unless having neurosurgery, then coordinate with surgeon.

B. Ventricular function - include most recent echocardiogram evaluation ideally performed within the past 2 years

C. Valvular heart disease- include most recent echocardiogram, type of prosthetic valve

D. Arrhythmias - include any implanted devices and recent interrogation report, contact electrophysiology about device management during the surgery and include recommendations provided. For A-Fib, include CHA2DS2-VASc score

E. Beta blockade - All patients on chronic beta blockers should have these medications continue throughout the perioperative period unless there is a specifically documented contraindication.

F. Hypertension - Other than for cataract surgery, ACEI inhibitors and ARBs should be held for 24hours prior to surgery and diuretics should be held the morning of surgery

G. Vascular disease - include antiplatelet management and dates of strokes

2. PULMONARY EVALUATION

A. COPD/Asthma - include any recent exacerbations, intubations, chronic O2 use, amount of rescue inhaler use

B. OSA risk - STOPBANG score - address severity of sleep apnea and CPAP use

3. HEMATOLOGIC EVALUATION

A. Bleeding Risk - assess the bleeding risk and history for every patient

B. VTE Prophylaxis/Thrombotic risk - estimate risk and provide recommendations

C. Anticoagulation management - include pre-op and post-op medication instructions

D. Anemia - pre-op treatment plan

D. Oncology - history and treatments

4. ENDOCRINE EVALUATION

A. Diabetes mellitus - include type, medication use, recent A1c, pre-op and post-op management instructions

B. Adrenal insufficiency risk - assess for prolonged steroid use in the last year

5. RENAL EVALUATION

A. CKD - include stage, baseline labs

B. ESRD - include dialysis schedule, type, access, dry weight, location of dialysis. Generally, surgery should not be scheduled on a dialysis day.

C. Electrolyte abnormalities

6. GI EVALUATION

A. Liver disease - including MELD score and Child-Pugh classification

7. OTHER relevant comorbidities or anesthesia considerations

[substance abuse, chronic pain, delirium risk, PONV (post-operative nausea and vomiting) risk, psych disorders, neurologic disorders, infectious disease, etc.]

[weightloss81]

Weight loss can offer a wide range of physical, mental, and emotional benefits. It's important to note that the specific benefits can vary based on individual circumstances, the amount of weight lost, and the methods used. Here are some potential benefits of weight loss:

Improved Health Markers: Losing excess weight can lead to improved health markers such as reduced blood pressure, improved cholesterol levels, and better blood sugar control. This can lower the risk of cardiovascular diseases, type 2 diabetes, and other chronic conditions.

Increased Energy: Shedding extra pounds can lead to increased energy levels, making everyday activities feel easier and more enjoyable.

Enhanced Mobility: Weight loss can improve joint health and mobility, making it easier to move, exercise, and engage in physical activities.

Better Sleep: Weight loss can alleviate conditions like sleep apnea and improve sleep quality, leading to more restful nights.

Reduced Joint Pain: Less weight places less stress on joints, which can help alleviate pain and discomfort, especially in weight-bearing areas like the knees and hips.

Improved Breathing: Losing weight can lead to better lung function and easier breathing, particularly during physical activities.

Reduced Risk of Certain Cancers: Maintaining a healthy weight is associated with a lower risk of certain types of cancers, including breast, colon, and ovarian cancers.

Enhanced Mental Health: Weight loss can have positive effects on mental health by boosting self-esteem, body image, and overall self-confidence.

Decreased Risk of Stroke: Weight loss, especially in individuals with high blood pressure or other risk factors, can reduce the likelihood of stroke.

Better Digestion: Achieving a healthy weight can improve digestion and alleviate digestive issues such as acid reflux.

Increased Fertility: For individuals struggling with fertility issues due to weight-related hormonal imbalances, weight loss can increase the chances of conception.

Improved Mood: Weight loss and regular physical activity are linked to the release of endorphins, which can lead to improved mood and reduced feelings of stress and anxiety.

Enhanced Heart Health: Weight loss reduces the workload on the heart, leading to improved cardiovascular health and a lower risk of heart disease.

Long-Term Health Benefits: Sustaining a healthy weight can lead to long-term health benefits and a higher quality of life as you age.

It's important to approach weight loss in a balanced and sustainable way. Crash diets or extreme measures can be harmful and may not lead to lasting benefits. Consulting with a healthcare professional or a registered dietitian before embarking on a weight loss journey is advisable to ensure that you're making healthy choices and setting realistic goals for yourself.

[z-h-i-e]

36. They say to Write What You Know. Setting aside for a moment the fact that this is terrible advice...what do you Know?

I end up on the fence on the 'write what you know' advice. On one hand, I do it constantly, but on the other hand, I'll go learn things so that I can write what I now know. It's that whole 'method writer' thing for me -- which is, undoubtedly, what I am, because I argue I'm more a storyteller who sometimes writes things down than a writer. Anyone who has spent significant amounts of time with me in Discord has gotten to hear headcanons and scenes and dialogue which may or may not ever be written. But I digress...

What do I know... I feel like I've lived a very blessed life in many regards because of all I've had a chance to experience. I am or have been all of the following: musician, artist, teacher, librarian, retail clerk, professor, politician, advocate, genealogical lecturer, consultant, writing coach, life coach, event coordinator/scheduler, manager, newsletter writer for a historical society. I ran my own business twice. I've worked in the public sector, private sector, and as an independent contractor. I've had many opportunities and had a chance to see things from many facets -- in theatre, for example, I've been a musician in the pit, an actor on the stage, and director behind the curtain, and a playwriter who should have been in the audience but knew the stage manager and got to hang out in the wings.

I seize opportunities - sometimes, I end up a little overwhelmed, but I (usually) overcome the obstacles and succeed. Where we came from and what we know makes us who we are. I was poor twice and middle-class twice. There's a big difference between eating ramen because it's what I could afford and eating ramen because I want to eat ramen (I'm eating ramen right now). All of those experiences start to seep into writing. When I was four years old I almost died. I spent the better part of a week in an oxygen tent. Since then, I've dealt with neurological and muscular issues that suck, but are better than the alternative. I didn't sleep, really sleep, until I was 35, when I was diagnosed with apnea. Sleeping scared me the first time I got a full 8 hours of uninterrupted sleep. 8 hours of unawareness. Nightmares were worse -- no one should have their first true nightmare in their mid-30s. That shit was really hard to unpack. My therapist should have been paid double the going rate for that year. (I'd had some weird fever dreams prior to that -- around ten years earlier, I had a second 'shouldn't have lived through that' experience when I rocked a temperature of 106 for several days -- but those were nothing compared to actual nightmares.)

Fanfiction is a much cheaper alternative to therapy (and, solidly gets an A+ from my therapist as one of my top coping mechanisms). It's journaling about life, it's sharing ideas, it's documenting daily journeys, it's fun and relaxing, and I've been doing it since I was 8. That is a significant stretch, really. The first piece was turned in as a school assignment. I used to write fanfiction for Super Mario Brothers, Rocky & Bullwinkle, Star Trek: The Next Generation, Teenage Mutant Ninja Turtles, and of course, ThunderCats. And I'd read it to classmates during class time, voices and all. I got to do my junior year cultural paper on Klingons, and I gave a lecture senior year on literary sources and their connection to the themes and storylines in ThunderCats. I have continued to read fanfiction in public at open mics and other events - it's the best way to mainstream and normalize it, and gosh darn it, it's been a far easier nerdom thing to normalize than furry bowling nights were. (I do miss furry bowling night, though. But I digress.)

So I do end up writing about things I know, and I've lived long enough to have a whole bag of holding full of experiences and memories to draw from -- and when I don't know something, I (usually) want to go and learn about it. I took up kickboxing and karate in college so that I could learn how to better write fight scenes. I spent a month of driving on my own to places I'd never been before to get into Fingon's head a little more (because you know, rescuing Maedhros was not the first time Fingon up and left on his own). I keep a bow at the door, next to my red shoes, because I think that's what Beleg would have done. I took the golden flowers growing at the house we live in as the sign that we should buy that house, even though it was a short sale and a pain in the ass to get through, because I was going to find a way to live in the House of the Golden Flower even if it took all summer (and it just about did). Then we planted strawberries there, for Samwise, because you know he and Rosie would absolutely have strawberries growing in their garden. (I can't take credit for the fox that lives in our yard - he showed up on his own - but it's as good of a second confirmation sign as any that we did end up in the right place.)

So that's a lot, and my lunch is almost over, but I almost feel like the question is less what do I know and more what do I not know. Everyone draws a line somewhere.

Horses. I do not know horses. Middle-earth has a lot of fucking horses in it. He's got a horse, she's got a horse, this elf over here's got a war horse, this other one has a war horse but it has jingle fucking bells on it... yeah. Lots of horses. Now, I'm in a state with lots of farms. Fair amount of horses. I see five different horses on my drive to work every day. Why is horses not a thing in the what we know category... well, I'm pretty convinced that with a head that size, you never know when one is going to open its mouth like an alligator and eat you. I'm not taking chances. Don't talk to me about logistics or physiology. I didn't make it this far in life to be eaten by a horse. So we're going to play it safe on this one and just read a book. I have a bunch of books about horses. Riding horses, fancyass dressage books, horse identification. People see my books, they say, wow, you must like horses! Hells no. You ever hear the whole 'keep your friends close, keep your horses that might eat you in two bites closer' line? Well, now you have. So that which I do not know and do not experience comes from books.

The end.

Thank you for your question, Anonymous.

[anshobecure]

Sleep Apnea Treatment in Ahmedabad: Restful Nights and Improved Health

Introduction:

Sleep apnea is a common sleep disorder that can have serious health implications if left untreated. In Ahmedabad, there are specialized medical facilities that offer effective sleep apnea treatment options. With a team of experienced sleep specialists and state-of-the-art technology, you can find the help you need to overcome this condition and enjoy restful nights.

Sleep Apnea Treatment in Ahmedabad:

Treating sleep apnea is crucial for improving overall health and well-being. Untreated sleep apnea can increase the risk of high blood pressure, heart disease, stroke, and other medical conditions. Seeking professional sleep apnea treatment in Ahmedabad is essential for managing the symptoms and preventing potential complications.

Surgery for Diabetes:

Did you know that surgery can be an effective option for managing diabetes? In Ahmedabad, there are experienced surgeons specializing in diabetes surgery. Surgical interventions, such as metabolic surgery, can help improve blood sugar control and reduce the reliance on medication. It is crucial to consult with a qualified diabetes surgeon to determine if surgery is suitable for your specific condition.

Endoscopic Bariatric Surgery:

Endoscopic bariatric surgery is a minimally invasive procedure for weight loss. It involves the use of a small camera and surgical tools inserted through small incisions, resulting in faster recovery and fewer complications. Ahmedabad offers advanced endoscopic bariatric surgery options that can help individuals struggling with obesity achieve significant weight loss and improve their overall health.

Doctor for Obesity Treatment:

If you are looking for a doctor specializing in obesity treatment, Ahmedabad is home to experienced and compassionate professionals. A qualified obesity specialist can provide comprehensive care, including lifestyle modifications, dietary counseling, and surgical interventions if necessary. With the guidance and support of a dedicated doctor, you can take control of your weight and improve your overall health.

Weight Loss Surgery in Ahmedabad:

For individuals with severe obesity, weight loss surgery can be a life-changing option. Ahmedabad offers a range of weight loss surgery procedures, such as gastric sleeve, gastric bypass, and mini gastric bypass. These surgeries can help achieve substantial weight loss, improve obesity-related health conditions, and enhance overall quality of life.

Conclusion: In Ahmedabad, you can find specialized medical facilities and expert professionals dedicated to providing effective sleep apnea treatment, surgery for diabetes, endoscopic bariatric surgery, and obesity treatment. It's important to consult with qualified doctors and surgeons who can offer personalized solutions based on your unique needs. Take the first step towards a healthier life by exploring the available treatment options and seeking the guidance of experienced healthcare providers in Ahmedabad.

[lenawilliams01]

Yoga and Pilates

Weight Clinic MD is a weight loss clinic that offers a comprehensive approach to weight management and obesity medicine. They provide personalized treatment plans that are evidence-based and FDA-approved. Their multidisciplinary approach includes virtual consultations, telemedicine, and compassionate care. Their weight management program addresses obesity-related health conditions such as type 2 diabetes, hypertension, sleep apnea, high cholesterol, fatty liver disease, metabolic syndrome, heart disease, stroke, and cancer. The clinic uses prescription weight loss medications such as Contrave, Saxenda, Qsymia, Belviq XR, Xenical, Topamax, Tenuate, Adipex-P, Bontril, Wegovy, and Monjaro to help patients achieve their weight loss goals. Nutritional counseling is an essential component of their weight management program. The clinic's registered dietitians provide guidance on healthy eating habits, meal planning, portion control, macronutrient tracking, calorie counting, food diary, nutrient-dense foods, balanced diet, and dietary supplements. They also offer fitness and exercise programs that include personal training, group fitness classes, cardiovascular exercise, strength training, HIIT, yoga and pilates, fitness tracking, and physical therapy. Mental health and wellness are equally important, and the clinic offers stress reduction techniques, cognitive-behavioral therapy, motivational interviewing, support groups, behavioral therapy, positive psychology, meditation, mindfulness, sleep hygiene, and addiction recovery programs. They also provide digestive health, sleep, metabolism, and hormone-related treatments. Low-carb diets, keto diets, intermittent fasting, Mediterranean diet, vegan, and vegetarian diets are some of the weight loss plans that they offer. They also provide Weight Watchers, Jenny Craig, and Nutrisystem programs. The clinic is located in a convenient location, and their pricing is affordable. Patients can expect doctor-supervised weight loss, personalized treatment plans, and bariatric surgery if necessary.

[theinformationpages]

The Surprising Benefits of Weight Loss for Health and Wellbeing

Weight loss is a goal that many people strive for, and for good reason. In addition to the obvious physical benefits of looking and feeling better, weight loss can also have a positive impact on overall health and wellbeing. Let's explore some of the benefits of weight loss.

Improved cardiovascular health: One of the main benefits of weight loss is a reduction in the risk of heart disease. Carrying excess weight puts extra strain on the heart and can increase blood pressure and cholesterol levels. Losing weight can help lower these risk factors and improve overall cardiovascular health.

Better sleep: Losing weight can also improve the quality of sleep. Excess weight can cause snoring and sleep apnea, which can lead to disrupted sleep patterns. By losing weight, these symptoms can be reduced, leading to better quality sleep and increased energy during the day.

Increased mobility and flexibility: Carrying excess weight can put a strain on joints and make movement more difficult. Losing weight can reduce this strain, making it easier to move and exercise. This increased mobility can also improve quality of life, allowing individuals to participate in activities they may have avoided before.

Reduced risk of diabetes: Obesity is a major risk factor for type 2 diabetes. Losing weight can reduce the risk of developing diabetes or help manage blood sugar levels in those who have already been diagnosed.

Improved mental health: Losing weight can also have a positive impact on mental health. Research has shown that losing weight can reduce symptoms of depression and anxiety, and improve self-esteem and body image.

Reduced risk of cancer: Obesity has been linked to an increased risk of several types of cancer, including breast, colon, and prostate cancer. Losing weight can reduce this risk and improve overall health.

Increased longevity: Losing weight can increase life expectancy by reducing the risk of chronic diseases and improving overall health.

In conclusion, weight loss can have a significant impact on overall health and wellbeing. By improving cardiovascular health, sleep quality, mobility, mental health, and reducing the risk of chronic diseases, weight loss can lead to a longer and healthier life. However, it is important to approach weight loss in a healthy and sustainable way, through a balanced diet and regular exercise, and to always consult with a healthcare professional before making any significant changes to lifestyle or diet.

Know more about natural weight loss supplement by clicking the below link.

https://theinformationpages.com/alpilean-a-natural-weight-loss-supplement/

[parentingwild]

This is my beautiful little family and this is just a slice of what our journey has been like.. Part 2 (Not a fully detailed version)

WARNING THIS CAN BE TRIGGERING!

After shift change in the morning her numbers kept dropping on the monitor. When the nurse examined me she discovered the cord around my daughter's neck. She grabbed the OBGYN and he examined me himself. He told us that we could give birth naturally but she could be severely injured or die in the process. He told us our second option was an emergency c-section. I was then rolled into the operating room and put to sleep. After my daughter's birth they pulled her father into a room where they were attempting to resuscitate her. After 3 doses of epi and the breathing tube being just small enough, she was revived. She weighed one pound 2 ounces and was the smallest baby we had both ever seen. She spent 162 days in the NICU which was accompanied by an infection that almost took her from us. During her stay we found out we were pregnant with our second child. We were told before the pregnancy that having a successful one after such an early birth would be dangerous and almost impossible. Once we found out I was scheduled to get stitches placed in my cervix at 12 weeks of pregnancy. I went to 6 appointments a month, 4 specialty and 2 OBGYN. At every specialty appointment we did an ultrasound that checked every aspect of my child and would take hundreds of photos and videos to monitor her. I would spend over an hour each time laying on the table being scanned. The whole pregnancy was accompanied with fear. Their father and I tried to not get too excited and honestly were a little disconnected because we knew the chances of her surviving were slim. During this time my first born had over 20 appointments a month. When she finally came home we had an oxygen concentrator, oxygen tanks, an apnea monitor, and a sp02 monitor.  Before our second was born We had her sister home from the NICU for 4 months. She was delivered via c-section at 37 weeks with no complications weighing 5 pounds 6 ounces! Everything seemed fine at first. We went home two days later. However, the day after we were back home my oldest got very sick and her and dad spent almost 2 weeks in the hospital. My youngest was exclusively breastfeeding at first and wouldn't get back to her birth weight and was losing at a concerning rate. She and I spent over 4 weeks during a few stays at the hospital after they came home. They examined her, tested her, made her calorie intake higher, consulted specialists, and tried to fix the problem every time. To this day she still has issues gaining weight. After weeks of no change and severe feeding difficulties she had a gtube placed. After about 3 months she was finally back to her birth weight. We are still in the beginning of our journey and looking for answers or solutions to what is going on with our children. 

When I had my first epidural to place the cerclage. They spent an extensive time trying to place it correctly and I had pain from it instantly. The pain spread and continued to worsen. Before my daughter's birth I had another epidural. They had the same issue and caused more damage. I tried to address it for several months and was told it was normal. It has now progressed to my whole body. I am in the most pain I’ve ever been in. This pain has been constant for months. I have lost a lot of my strength and my body is constantly aching.