purplekow

I remember liking hi at the time, now his jokes about the South Bronx seem insensitive.

Sorry that the window seems to have closed but time can play funny tricks. Keep his memory warm in your mind and perhaps some day you will have his body to keep warm in your bed.

I was of course assuming Coronavirus was not an issue. In my case though, I would probably be better off in Palm Springs on vacation than here in NJ working, even with a few days off.

I would be sitting at the pool at Canyon Club right now oogling the men and catching rays. I would probably be on my way to breakfast at Rick's with Vin Marco and some of the members here. Miss those pancakes and of course the hot sausage.

Been getting my dose of Meloni melons in his show Happy on Netflix. An odd show and he is not looking his best but that ass is still smoking.

first of all, maintenance while requiring work does not require the kind of work needed to get that physique in the first place. One escort I have seen a few times just dropped me a text with a video and he looks better than ever. I asked him what he was doing and he was just doing stretches and body weight exercises like pull ups and sit ups and push ups. Another escort with whom I regular communicate is out bicycling in some fairly mountainous terrain, 4 hours of 50 miles or so of bicycling will keep those thighs and butt in top shape and more ripped than ever.

Only problem is some of them will not be by the end of the day.

Yes we have extracorporeal oxygenation and have tried it but that is not usually a long term solution. Things do seem to be slowing down just a bit at the hospital at which I work and we are getting more and more therapeutic options. We are doing an in-house 150 patient study on the effectiveness of hydroxychloroquie vs placebo vs hydroxychloroquin + zithromax We are also starting to use antivirals and convalescent serum but the anti IL 6 drug Tocilizumab still is the one showing the most benefit. We have success in getting a few more people off the respiratory. Still only 4 out o 56 with 27 still on ventilators but as of last week we had not gotten any people off. We are also intervening to try to avoid artificial ventilation. We have had a few people be right on the edge and then turn around with the Tocilizumab. As for me, I was told to take the rest of the week off and to return next week. While there is a relative lull and there is a full staff, they are trying to give people time off so that people will be fresh if there is a further surge. NJ is still seeing increased cases though NY seems to have leveled off. While I understand the reasoning, I tried hard to convince the powers that be that I am fine and to give someone else time off. There are definitely inspirational people working a lot harder than I have been. But, while I have been a general most of my professional life, now I am not a general and so I am acceding to the request, with a noted protest. At the hospital they have changed the song for success to (This is my) Fight Song. Now there is discussion of changing it again because it is loud and harsh. So while the idea of a victory song was a good one, finding the right one has been a bit of a challenge. So I will be calling in each day should there be an unexpected event such as a provider illness or a critical surge but I have off until next Tuesday. I cannot help to think that I would have been leaving for Palm Springs and would have been there until Tuesday. My house is not bad but I do miss the fun and the interaction of Palm Springs Get Together. Hello to all the guys and next year is a plan.

Cats seem to be prone to covid19 though it is not thought that animals can pass it to humans. As for dogs, at one one dog was tested and found to be positive but why it was tested and if the test was reliable, I have no knowledge of that. I have made arrangements for my dogs should I get sick or pass. I think being home with a dog is great but you do need to watch out for separation anxiety. If you do decide to get a dog, I would make sure you left the house for some time during the day to get it used to being alone. Or get two and they will have each other. I have had as many as seven dogs at once and they Ade the most difficult times of my life bearable.

Talvin was a hot escort and I am sure he is a hot guy in whatever profession he is pursuing now.

Matt, Tocilizumab is being used in a variety of places. Antivirals are also being used in some places here in NJ with some reports of success. We are starting convalescent serum protocols this week. I am sure Dr. Fauci is aware of these drugs but as for the rest of the administration, who knows. Tocilizumab is not a cure all but in the right setting at the right time we have had success with it. The last thing that would be needed is for someone in a position of power to start talking it up as a cure all and suddenly the use of the drug becomes inappropriate. At my hospital, I as the primary care provider can only request that the ID specialist give permission for it to be used. I have done so three times and all three times it has been beneficial. In fact, all three have gone home after looking for all the world as though they needed to go on a ventilator. It is used to prevent cytokine storm which is a result of the damage that the virus has done and it does not kill the virus at all, so if you are not in danger of imminent cytokine storm, it is not of use. There is also an investigational drug. Otilimab which is a GM CSF inhibitor. (Granulocyte Monocyte Colony Stimulating Factor) inhibitor.. GM-CSF also induces a rapid production of white blood cells to help fight infection and may be overproduced in CoVid. The drug is probably being used but I am not familiar with it in CoVid or otherwise. There are several of these drugs used for multiple sclerosis which are designed to inhibit immune response. They all have toxicity but may be worth the risk in Covid but I have not seen data about it.

I watch Politician with Ben Platt. Interesting considering it is set in a high school. Platt's character has oldertwin brothers, in their 20's, who are seen infrequently without shirts. They are hot but not on screen enough to make it worthwhile to watch for them alone.

Well today is the last day of my break. I received a call from the doctor covering for me. She told me that the mother of six who seemed destined for the ICU responded well to the tocilizumab and improved almost immediately after given the drug. She continued to improve over the weekend. We also used anticoagulation on her. If those meds did anything or if she was just destined to get better you can never be sure, but I will be using that combination again. Another woman in her 50's also seemed to turn around yesterday after the tocilizumab. I had mentioned previously that this is a interleukin 6 inhibitor. Interleukin 6 stimulates cytokine release. Cytokines are vasoactive and inflammatory chemicals usually released in a control manner to fight infection but in this disease they are released in a manner called cytokine storm and though the infection is hindered, those chemicals worsen the damage. So the key it to get the cytokines under control at the proper time. In addition, we have been using anticoagulation to help treat these patients. The patients are noted to have an elevation of a substance named D Dimer which elevates at the time of blood clots in the lung. The CoVid patients do not have large clots, pulmonary emboli, but it is thought there are many many small clots which cause oxygenation problems and which cause the D Dimer to elevate. So now, when we see the D Dimer elevating, we are adding anticoagulation to try to prevent as many of those small clots as possible. None of this is standard, but so far we have had some success. While I was on the phone with the covering doctor, she started to have a catch in her voice. It was clear she was becoming emotional and I asked her what is wrong. She told me they had just played "the song" and she was still getting used to it and hearing it gets her emotional. What has happened is, someone came up with the idea that each time someone is discharged or has the tube removed from their throat, the play a brief burst of a song over the intercom. Today they were using Oh Happy Day. This is a new idea since Friday and I think it is a wonderful way to let the people in the hospital know, that there are successes. They only use the first two lines. (oh happy day, oh happy day, oh happy day oh happy day). Just a brief break in the efforts. Kind of like hearing a bell and knowing an angel got its wings. We also had the first person make it successfully off the respirator. I believe I had mentioned a healthy 60 year old gardener who came in and looked good and then in the morning was admitted to the ICE and placed on a ventilator. Well, I think it is 8 or 9 days later and he was extubated. The first one to get off the ventilator. I had been posting here that people were not getting off the respiratory. Now general reports are coming out that 80% of the people on respirators or even more are NOT making it off. So the plan now is to do everything possible to keep patient off the ventilator. So we are using more of the Tocilizumab to assist in that. I am rested and physically able to go back. Mentally it is still a struggle, but I am sure I will be ready in the morning. https://video.search.yahoo.com/yhs/search?fr=yhs-dcola-015&hsimp=yhs-015&hspart=dcola&p=oh+happy+day+song+you+tube#action=view&id=12&vid=ddd71b238b7b91fee7bada6b29e4aff0

Well even though I have the 4 day break, I am still receiving phone calls about the new admissions. Things seem to have slowed down this afternoon. The ER has usually had 30 to 50 people being treated and a dozen or so waiting admission. The first all I got today was at 6:30 PM and there is only one other patient awaiting admission. An Easter miracle? Wealthy are predicting that here in New Jersey the pack should be between April 10 and April 27 so we are in the midst of the period when a slow down should happen. Maybe this is a sign of that slow down. People have been doing social isolation and perhaps that is turning this a bit around. So a rare glimpse of good news. Stay safe. I will be back to work Tuesday so I am gearing up with lots of sleep and getting ready.

I. checked in to the hospital to see how the team was doing and if anything was new with the patients. Good news for the two men who were not discharge on Thursday, they both improved and arrangements were made for hoe oxygen, The hospital administration was convince that it made economic sense to send these men home on the oxygen at the hospital's expense than to keep them in the hospital for oxygen with the hospital picking up that bill. After a long discussion of precedents and numbers, the administration relented. It is better for the patients to be home and better financial for the patients to be out o the hospital. A one time expense for an oxygen concentrator is worth it.

ENT at this hospital rarely come to the hospital and do so under duress. If I wanted to spend a few hours arguing with people I could have gotten one to come but they would have come for a posterior bleed. Of course, a Foley catheter or two can handle that in a pinch. As to managing nose bleeds, I used to use a touch (but not too much of a touch) of silver nitrate on a stick or a lidocaine with epi soaked cotton ball packing. Ice to the bridge is not great but if the bleed is not too bad I have had some success getting the bleed to stop while we were getting the other methods ready. We also had cocaine to treat nose bleeds in the walk in back in the day. When I opened my walk in and when I worked in one in 1979, they handled much more than just coughs and colds. The facilities were looked down upon and called "doc in box" but I always contended that they served a need and were a great alternative to ER visits. At each hospital at which I worked , I spoke up for having several of them associated with the hospital. but the old guard did not see the advantage. There subsequent proliferation speaks to the utility of the facility. Much cheaper than Emergency visits and if staffed properly a great triage to all the ER to handle actual emergencies. .

I was on the phone with a grade school friend of mine who is a lawyer. Another call came in from the hospital and I excused myself and took the call. I got back to him in about a minute and when I did, he asked, "Good News?" I could tell it was a serious question but I just started laughing and laughing, I told him, I have been doing this for decades and if there is a phone call from the hospital, it is never good news. No one ever calls and says". "By the way, we cured cancer this afternoon." The only reasons for a call from the hospital is bad news and really bad news. This was just a bad news call, which was a relief. I had several patients, including the mother of 6 who have taken significant turns for the worse and a call, especially a call when you are not on call, easily could have been a very bad news call. As it was, the patient with the low platelet count had not responded to the initial doses of medication, which was expected outcome as it usually takes a few doses to stimulate the bone marrow and get the count elevated. The bad new was that his nose bleed which was just an occasional spot of blood when he blew his nose, had gotten worse and now is was a matter of whether or not someone going to go in and packi his nose in order to control the bleeding. As I have mentioned before, a major stress for the care providers with this virus is the increased level of work needed just to provide routine care. Someone needed to go in and see if this was just an anterior bleed, with blood coming out the nose which has a quick fix, or whether this was a posterior bleed with blood dripping or pouring down the throat, which usually requires a higher degree of tamponading. I asked the nurse to ask the patient if there was blood going down his throat. He said he did not think so, so blood was not pouring down the throat. I asked her then to take an ice pack and have the patient hold it on the bridge of his nose for ten minutes and if the bleeding was continuing, I would go in and pack it. There was no way an ENT was coming in to do this procedure and surgical residents are only seeing "emergency" cases and this did not meet that criteria. The medical residents for the most part do not have the experience in this type of procedure and they are not certified for it in any case. So that left the ER docs, who are overwhelmed with incoming patients or me. Clearly if was going to get done, it was going to be me. Having finished laughing, I finished the conversation with my friend and began getting dressed in case I needed to go in. One thing the pandemic has done is really lower the standard as to what people are willing to be seen wearing. However, even by the current low standards, my sweat pants with several holes in the butt and a convenient hole that allows for mindless genital stroking was not going to do it. Dressed and ready to go, I called to see if I needed to go in. The bleeding had slowed, the nurse had looked in his throat and there was no blood coming down (an act above and beyond the call of duty) and she would continue the ice. I told her to give the patient a sterile gauze pad and instruct him to roll it up and gently place it in his nose. As I listened, she told the Creole interpreter, I know I did not mention the patient did not speak English but language line is a beautiful feature, to tell the patient what to do and it was done. So from my home to the hospital room to the unknown location of the language line office, to the home connection of the Creole interpreter to the patient in the bed. We all stopped his nose bleed and that was a great thing for him and for me. No further calls from that nurse, though I learned the bleeding stopped and the patient felt better. He was able to resume using his oxygen by nasal cannula the trauma of which probably caused the bleeding in conjunction with the low platelet count. They did not call to tell me that the bleeding had stopped, because you never get good news when you get a call from the hospital.

Just to be clear, I am not condoning this as a safe practice, There have been a very few anecdotally reported cases of a second infection out of China but those numbers are minuscule. It may be that China is once again being deceptive about their numbers. We will have to see I we start getting second infections here. So I suppose he could have a second case, but the odds are tiny or so it seems. So the question is still worth asking. In addition, they are now taking plasma from recovered patients and testing those antibodies as a treatment for the acute infection. There is not doubt that antibodies form, the question is their duration and effectiveness in staving off another infection with a slightly mutated coronavirus which is different than the initial infection. The hospital where I work is part of the study though we have not started using the treatment yet. We need to have enough people recovered for.a month, that is the time being used to allow donation. In the meanwhile, would that make a difference to you is my question and at least initially, the forum seems to state that it would not make a difference, they would not hire.

There is some evidence that there is brain activity after the heart has stopped and breathing has suspended. This would be classified as dead and so, even after you are dead, you would not be alone, you would be aware, for a short period, of others around you.

I know an escort who had Covid and now is 14 days after the infection. Theoretically he is cured or soon will be. If he could show you a positive test from a month ago, would you consider hiring if all the other boxes checked off? I do know this escort and I am personally acquainted with his results so it is not a scam, but we are working in the theoretic right now.

Well I made it to my four day weekend. A new schedule for the Coronavirus has us working for 10 days and then off for four. It does not sound so bad, but if had been 11 and then 4, I am not sure I could have gathered the strength to get back into the gowns and masks and overheated rooms. The patients keep coming. On some of the floors they are now mating patients who have similar medical needs so that you can have two patients in. an isolation room. This will also allow for two patients to share one ventilator if it should come to that. Today I only had 10 patients, all Covid and there was hope for 4 of them to go home. The average age of the patients was 44 the mean was 37. The oldest patient is 81 and he has other medical problems and if not for those, he would not be in the hospital due to Covid. The hope is that the CoVid stays mild and the other issues, including a platelet count of 3000. Uusual platelet count is 140000, minor problems can start at 75000 and below 20000, some type of treatment is generally necessary. He is doing well so far and our hope is to get the platelet count up and him out of the hospital by the weekend. Of the other 9, discharging 4 was the goal and keeping 2 out of the ICU was the bigger goal. The other 3 are kind of in a holding pattern for now. Sick enough to be in the hospital, too sick to send home, but no so sick as to require intense treatment. Of the four going home, two were actually discharged. A 32 year old with Covid and a renal stone and a 37 year old with Covid and accelerated hypertension. In both of these cases, the CoVid just made the treatment of a common medical problem more complicated. There is always the donning of the gown to get into the room. Sending patients for tests and getting specialists to see the patients is much more difficult. Specialists, such as ID and pulmonolgists are boots on the ground full steam ahead busy. Others, such a neurology and gastroenterology are a lot less busy as their fields of expertise are not usually a major component of a serious component of the CoVid infection. So some are inundated and others are quarantining at home with their families. I known the media is fond of making health care workers during this plague seem like marathon runners down to the last bead of sweat, unclear as to whether they will make to finish line without a complete physical collapse. To be fair, there are some doctors and just about all nurses who fit into that category. But there are a few doctors, though they are suffering finanacially, professionally, they are sitting this one out, at least so far. When a staff of a hundred or more internists were asked to volunteer to help out the 25 or so doctors doing the yeoman's work in the hospital, how many would you have expected to volunteer. If you guessed most, you are way wrong. A quarter? No but thanks for playing. Surely a dozen? No no no. A handful? Only if you had a finger amputated. That is right out of about 113 doctors not already actively caring for these patients, 4 volunteered to assist should the medical team in the hospital not be able to handle to load. Now we have 35 residents but they do not manage patients independently and in this crises, they, so far, have been exempted from the routine examination of the patients though they do handle emergencies and order writing as guided by the attending physicians. Now the group of physicians caring for partients, about 90, 25 on ventilators and numbers increasing every day, include a team of 5 intensive care specialists, 5 hospitalists, 3 infectious disease specialists, 3 full time faculty members and occasional other specialists like renal doctors who may need to oversee dialysis. That is for around the clock care and a steady influx of new patients and the inevitable death of others. We have not gotten to the point as they did in Italy where they simply made patients considered non salvageable, not my term, comfortable and allowed them to pass with minimal medical intervention. So, if you are looking for heroes, look to the nurses. In and out of room after room. Trying to meet every need from life saving treatments to face saving bedpans. You see, even a bedpan requires someone to gown up, a process that takes 3 to 5 minutes if done carefully and go into the room. This is a job which might be done by less skilled individuals during usual times, but those people are not generally going into the room. So now to the two patient that did not go home though we had hoped they would. These patients are almost identical twins in a clinical sense. Both are physically active Mexican blue color workers in their mid 30s. Both had been sick.for 10 days or so before they came to the ER and both are otherwise healthy. Both had been tested for CoVid and knew they had it. One presented with diarrhea and the other with cough but neither was very sick when they came to the ER and both could possibly have been sent home to recover with instructions to return I things got worse. Both men had slight blood tests abnormalities which suggested that their course may be a bit rocky, and so both were admitted with the idea that they should be able to go home in a day or two. Now two days after each was admitted, they looked to be ready to go home. The man with the diarrhea had improved and was able to eat. The man with the cough and fever had not gotten worse. Neither was needing oxygen and so they were told that they would be going home. The man with the respiratory complaints began to cry when I told him he was going home. He told me :No quirero morir sin nadie, (I do not want to die alone). I tried to reassure him and he eventually collected himself. Two hours later he was unable to fully oxygenate and was clearly short of breath. I kept him in the hospital. His twin, was told he would go home and he was stoic about it. I noticed he had a slight cough but when I pressed him about it, he said that he was coughing up mucous and was feeling short of breath when he walked around the room. His monitor did not show him losing oxygen when he was walking. But the cough, the symptomatic shortness of breath without oxygen desaturation and most of all a half cup of thick brown mucous convinced me he should stay. I told him he would stay one more day. That is when he started to cry. He admitted that he was afraid, something he denied flat out when I asked him if he was afraid early in the visit. He was afraid that he was going to die alone and he thanked me for letting him stay in the hospital even though that meant things were not doing was well. . I think it is interesting that the fear that both of these men expressed is that they were afraid of dying ALONE. I think all of us have come to some internal understanding that we are not here forever but it is the fear that when we are leaving we will have to do it alone that terrifies people. It is also clear that people in the hospital with Covid, all of them with the mental capacity to understand their disease, know that they could die from this and that it could be just hours away. Even so, what they fear most is dying alone. That is what is so cruel about this disease. There are no visitors. There is no one to hold the hand, to shed a tear at the bedside, to say a prayer or to whisper that it is alright to let go. Nurses are there though. Thanks to all that is holy for them and their efforts

So you are thinking that this pandemic is going through the summer then.

Travel brochures. When this is done, I am headed to Tahiti and possibly Australia. You cannot keep putting off the future so give yourself a present. This is my new motto. That and "Mamas en la cama" which is my quick saying to my Covid patients who speak Spanish and need to prone.

I mentioned keeping you eye out for the sneak. Well, tonight, my dear canine friend Mr. Bear was the sneak. He passed just about when I finished my previous post. All week long I have been preparing. I would have a bit of a final visit each time I went to bed, because I was not expecting him to make it through the night, Then in the morning, he would still be there, wagging his tail when I called his name and lifting his head ever so slowly in my direction. He had stopped eating despite coaxing with some pretty good favorites of his. So he did not totally sneak away. When I would leave for work, there would be little confessional of love and most times, depending where he had settled, I would look in from a window or through the backyard foliage to get what I thought be my last glimpse of him. Then , each evening he would still be there. A little weaker, a little grayer but still with a wag of a tail though he had stopped coming to greet me at the door. Tonight he actually seemed a bit perky, He drank some water and though he did not move much, he did keep himself in the warmth of the sun the window let in. When I came to write my medical notes and then my posing here, I stepped over him and gave him a casual "How ya doing Bear boy". Soon after, he snuck away before I could hold him and pat his head one last time. Damned sneaks, the give you just a moments peace. They lull you into a space where everything seems like it always is and then they turn all of your expectations up side down. Well I got him up from the floor to the ottoman where he usually slept. I cleaned up the the area and I am set to go to bed. I decided to write this now so that the reality of it sets in and I can get some sleep knowing that my life has been better with him in it and that I hope he felt the same. Goodnight bear, you old sneak. I'll miss you. I see you after my work is done.

Similar to proning, expanding the lungs may recruit more oxygenation, It will not prevent severe coronavirus, but it may improve your response to the cytokine storm by having more alveoli open, I must admit I did not watch the video but as a respiratory therapist, I used to instruct patient's in these exercises and I used to do percussion on the chest to help mobilize secretions. All these things help a bit. However, just because you do something a bit differently and you make it to the other side, does not make it so that the action is what got you there. There was something on Facebook that said the Plaquenyl had 100% success rate in one hospital Either totally fake or totally misleading (two people used it two people got better). So if it does not requite professional time and special equipment , I will give most things a chance. While we are still learning what works best, these type of things such as lung exercises do not usually make a massive difference. Does it make sense that some well practiced exercises can change how your lungs function in a short enough period od tie to prevent a major disease? Not for me. Now a short course exercise to get 6 pack abs, I buy that.