purplekow

If you have video or erotic pictures of yourself, have you ever used it for masturbatory purposes. In other words, have you even gotten yourself off by watching yourself on video, in pictures or in a mirror?

Just as a comparison, recent recommendations for hydroxychloroquine (Plaquenyl) the original trump panacea, are that it should not be used as an outpatient only in hospitalized patients and then with caution. Reported that twice as man deaths with HCQ as without. Again, one report and most recent recommendation. It is still being used. So do not jump off or onto the Remdesivir bandwagon, let it get to the end of the trial before deciding.

We are getting more and more non Covid admissions but only those that cannot be treated at home are staying for any period of time. With so many Covid patients in the hospital, the possibility of contagion is high for those Non Covid patients who are in the hospital, However, patients are still be treated for other things. Right now I have 11 patients, 8 are Covid and 3 not. Of those, tomorrow 4 Coiv and two not will be going home. Admitting today, so will see what the morning brings.

Covid, in some places has overwhelmed the health care system. Some of the first Covid cases we saw at the hospital were doctors and medical office staff. People did not realize that, yes that migraine could be Covid or that diarrhea could be Covid or that sinus congestion could be Covid and that back ache, yep Covid. So the little old lady coming into the office gets Covid in the waiting room or from the staff member taking her blood pressure. We have gotten much smarter about it and I think doctors will be coming back to the office. if a problem can be taken care of with a video visit, that will be the option most providers will take. That method is safer for the patient and for the providers. I do not like it and I think most providers do not like it, but for he near future, Covid rules medical care. The physical can wait. The prescription change can be called into the pharmacy. The swollen, red leg can be done over the video. I would think doctor's offices will start having patients come in for an appointment and have the patients use their car as the waiting room. My cousin wanted an appointment with her doctor and was told she would not be seen until after she had a negative CoVid test. That order was called in, She was looking to be seen for a Gyn problem but as fate would have it, she had Covid. As much admiration I have for nurses and other personnell as well, during this crisis, I have to admit most doctors have not stepped up. Hospitalists, Intensivists, ER docs all working diligently night and day. Backbreaking and dangerous work. Anesthesiologists, some are great, others are absent. Other specialities? it is really hard to get them to come into the hospital to get things done. A lot of things are being put on hold, not just elective surgeries but other non urgent surgeries as well. Try and get a colonoscopy for a patient for bleeding better jump through every hoop they put up even then it is nearly impossible. An elective colonoscopy? You would have more luck finding a dodo in a Blockbuster Video. So to answer your question, just like almost every other field, medicine is now shaped by Covid. Medicine, is for the most part All Covid all the time. Yesterday I have 8 patients admitted to the hospital, 7 were Covid, Three of those had something else but they had Covid too. The other, had a cardiac issue for which he got a stress test and an appointment for a cardiac catheterization next month, Will they be doing them electively next month? who knows. So medical care for now and intervention, if needed, later.

It is PK as I am rarely PC.

We are involved in two Remdesivir trials. One given to very sick patients who are on a ventilator and one given to patient's earlier in the course. It is too early to tell and it is definitely so that the leaked results were either Apocrypha or designed to get a stock bump. That said, we have had a few patients make great improvement in the late use arm of the study. I am not privileged to the actual data but we are a small site so compared to the worldwide nature of this study, a drop in the ocean, We have not used it in the early use arm of the study yet. Early reporting either pro or con has to be taken with a grain of salt, but while this will not be a panacea, it looks to have a role in late use but do not bust out the fireworks until the study is said and done.

He was an answer on Who Wants to Be a Millionaire tonight. Jane Fonda had a question as to which one of the following people did not play Colonel Sanders in a KFC commercial. Norm MacDonald. Rob Lowe George Hamilton David Spade. Jane did not know who Norm MacDonald was but did get the answer of David Spade, who she did not question who he was. So Spade is up one in the Q rating war with Norm MacDonald. Jimmy Kimmel who is hosting this brief reboot dropped that MacDonald was the celebrity who had won the most money on Celebrity Millionaire, which was $500000.. I believe. Jane herself could have had a $500000 question if she trusted her Phone A Friend and answered that it was Lima Peru not Reykjavek Iceland that was in the same time zone as NYC. She decided to walk with 125000 for her charity.

He was an answer on Who Wants to Be a Millionaire tonight. Jane Fonda had a question as to which one of the following people did not play Colonel Sanders in a KFC commercial. Norm MacDonald. Rob Lowe George Hamilton David Spade. Jane did not know who Norm MacDonald was but did get the answer of David Spade, who she did not question who he was. So Spade is up one in the Q rating war with Norm MacDonald. Jimmy Kimmel who is hosting this brief reboot dropped that MacDonald was the celebrity who had won the most money on Celebrity Millionaire, which was $500000.. I believe. Jane herself could have had a $500000 question if she trusted her Phone A Friend and answered that it was Lima Peru not Reykjavek Iceland that was in the same time zone as NYC. She decided to walk with 125000 for her charity.

I have been back to work for a few days but I have not had time to report back here. I would think that most of you have Covid fatigue so perhaps a break from my posting here was just the cure you needed for that. That, and not watching any form of information at all. While I was off, I avoided all radio and television except for Netflix and HBO. The world seemed almost sane. Upon my return to work, things seemed under better control. I do not know if we had gotten used to the chaos or if during my time away, the chaos had magnified in my mind and the reality of it did not seem quite so enormous. That feeling lasted for about an hour and then the reality of the situation set in. However there is one particular episode that I would like to write about today and a group I would like to salute. I went into see a patient today who had been taken off a ventilator after 14 days. He was doing surprisingly well and he had been treated with all therapies availbable at this hospital except human plasma which was not available at the time he was his sickest. I gowned up. Gown, two masks, face shield, two sets of gloves and headed into the room. The ambient temperature was about 82 degrees and I later learned it was that way in most of the rooms because the patients tended to be cold and they only have a light sheet to cover themselves. The skimpy hospital gowns do not add much for warmth either. I spoke with the man, a nice guy from Peru who happened to be visiting a friend when he became ill and was brought to another hospital about 50 miles away. He had an endotracheal tube placed and as there were no ventilators available at that hospital, he was sent on an hour ambulance ride with someone or more like two people alternatingly pumping an Ambu bag. Ambu bags, for the uninitiated are rubber football shaped items with a valve to attach to an endotracheal tube and an entry port for oxygen which can be manually squeezed to pump air into the lungs, usually for short periods of time, but it can be done for as long as fresh hand muscles are available for the squeezing. I asked him about his recall of the preceding events and all he could recall was going to the hospital and then waking up here two weeks later. The drug induced coma had done its job effectively. As I was talking, there ws a knock on the door and I went to the door and was asked if I would deliver his tray and take his vital signs while I was in the room. I did so, waiting impatiently for the thermometer to beep once I had place it in the patient's mouth. I walked it back to the door and showed the result to the nurse outside. The machine which took the vital signs was then wheeled to the door so that they could be noted in the patient record. I spoke to the patient further and he told me he needed to urinate. I went to the door and got the nurse to bring me a urinal. She did so promptly and I brought it to him. He had some type of underwear on, I am not sure from whence that came as most patients, at least male patients, go commando, He could not manage to get his equipment out of the briefs nor could he manage the get them down. He asked for an assist. I helped him slide them down. (now those of you who are making a porno movie in your mind from this should know....this was not at all sexy) and gave him the urinal. Unfortunately the prolong time in bed on a ventilator had made it difficult for him to stand and also made it difficult for him to arrange the urinal properly. I helped him up, setting off all sorts of alarms and then took the urinal and found just the right angle to allow him to urinate into the bottle without missing a drop. I then helped him back to bed and tried to turn off the alarms. Even with explicit instructions from the nurses outside, eventually one of them had to come in to show me how to do it. With the patient settled, I was able to leave the room and received a round of applause from the small group of nurses standing around the hallway. I had been in the room 7 minutes or so. My mask was fogged. My arms were sweaty. I was breathing heavily from the heat and the masks. I needed to sit down. One patient. 7 minutes. That was enough to have me needing a long drink of water and a 10 minute sit down. Now to the point. These amazing women and a few men do this for hours at a time. They get into and out of gear more than a dozen times a day. They are taking care of 2 to 4 of these amazingly sick patients and they do it hour later hour and day after day. They rarely get to sit and if they do it is to write a note or talk with a family on the phone. They give medications. They make clinical judgements that have life and death consequences. They make the bed, take the temperature, comfort the patient, talk with them and hear their fears. They listen especially hard because these patients do no have visitors and the only real sustained human contact they have is their nurses. I have seen nurses arrange FaceTime interactions for a family who wanted to see their matriarch one last time before she succumbed to the disease. They relay patient messages sometimes through translation services to patients whose families are hundreds or thousands of miles away. They need to answer the questions, get the medications, arrange the tests and get the patient orders from the doctors. They need to face the possibility of contracting this possibly fatal disease from patients who are unable to avoid coughing on them or who grab them unexpectedly. These are women in their 20s, many mothers of young children who come in to work every day, middle aged women who have seen it all and done it all twice. There are senior nurses, some back from retirement because they could not sit home and allow someone else to do it alone. I cannot express in words the admiration I have for these practitioners. They do not get a round of applause like I did when I managed to take a temperature and helped a man avoid peeing on the floor. They are getting some recognition now but not nearly enough. They are the cornerstones in this battle against this disease. These daughters, mothers and sisters are the front line, down in the trenches soldiers carrying the heavy loads and doing so willingly and without complaint. They deserve any accolade that might be sent their way and a hundred times more for each of the mercies they complete. So If you read this and you know a nurse text her, phone her, send her a card and give her a heartfelt but in these times, a virtual hug and a round of applause. It made me, someone who was only a 7 minute nurse, know that someone was watching and appreciating the effort, I think the 24/7 nurses deserve much more than that.

I have been back to work for a few days but I have not had time to report back here. I would think that most of you have Covid fatigue so perhaps a break from my posting here was just the cure you needed for that. That, and not watching any form of information at all. While I was off, I avoided all radio and television except for Netflix and HBO. The world seemed almost sane. Upon my return to work, things seemed under better control. I do not know if we had gotten used to the chaos or if during my time away, the chaos had magnified in my mind and the reality of it did not seem quite so enormous. That feeling lasted for about an hour and then the reality of the situation set in. However there is one particular episode that I would like to write about today and a group I would like to salute. I went into see a patient today who had been taken off a ventilator after 14 days. He was doing surprisingly well and he had been treated with all therapies availbable at this hospital except human plasma which was not available at the time he was his sickest. I gowned up. Gown, two masks, face shield, two sets of gloves and headed into the room. The ambient temperature was about 82 degrees and I later learned it was that way in most of the rooms because the patients tended to be cold and they only have a light sheet to cover themselves. The skimpy hospital gowns do not add much for warmth either. I spoke with the man, a nice guy from Peru who happened to be visiting a friend when he became ill and was brought to another hospital about 50 miles away. He had an endotracheal tube placed and as there were no ventilators available at that hospital, he was sent on an hour ambulance ride with someone or more like two people alternatingly pumping an Ambu bag. Ambu bags, for the uninitiated are rubber football shaped items with a valve to attach to an endotracheal tube and an entry port for oxygen which can be manually squeezed to pump air into the lungs, usually for short periods of time, but it can be done for as long as fresh hand muscles are available for the squeezing. I asked him about his recall of the preceding events and all he could recall was going to the hospital and then waking up here two weeks later. The drug induced coma had done its job effectively. As I was talking, there ws a knock on the door and I went to the door and was asked if I would deliver his tray and take his vital signs while I was in the room. I did so, waiting impatiently for the thermometer to beep once I had place it in the patient's mouth. I walked it back to the door and showed the result to the nurse outside. The machine which took the vital signs was then wheeled to the door so that they could be noted in the patient record. I spoke to the patient further and he told me he needed to urinate. I went to the door and got the nurse to bring me a urinal. She did so promptly and I brought it to him. He had some type of underwear on, I am not sure from whence that came as most patients, at least male patients, go commando, He could not manage to get his equipment out of the briefs nor could he manage the get them down. He asked for an assist. I helped him slide them down. (now those of you who are making a porno movie in your mind from this should know....this was not at all sexy) and gave him the urinal. Unfortunately the prolong time in bed on a ventilator had made it difficult for him to stand and also made it difficult for him to arrange the urinal properly. I helped him up, setting off all sorts of alarms and then took the urinal and found just the right angle to allow him to urinate into the bottle without missing a drop. I then helped him back to bed and tried to turn off the alarms. Even with explicit instructions from the nurses outside, eventually one of them had to come in to show me how to do it. With the patient settled, I was able to leave the room and received a round of applause from the small group of nurses standing around the hallway. I had been in the room 7 minutes or so. My mask was fogged. My arms were sweaty. I was breathing heavily from the heat and the masks. I needed to sit down. One patient. 7 minutes. That was enough to have me needing a long drink of water and a 10 minute sit down. Now to the point. These amazing women and a few men do this for hours at a time. They get into and out of gear more than a dozen times a day. They are taking care of 2 to 4 of these amazingly sick patients and they do it hour later hour and day after day. They rarely get to sit and if they do it is to write a note or talk with a family on the phone. They give medications. They make clinical judgements that have life and death consequences. They make the bed, take the temperature, comfort the patient, talk with them and hear their fears. They listen especially hard because these patients do no have visitors and the only real sustained human contact they have is their nurses. I have seen nurses arrange FaceTime interactions for a family who wanted to see their matriarch one last time before she succumbed to the disease. They relay patient messages sometimes through translation services to patients whose families are hundreds or thousands of miles away. They need to answer the questions, get the medications, arrange the tests and get the patient orders from the doctors. They need to face the possibility of contracting this possibly fatal disease from patients who are unable to avoid coughing on them or who grab them unexpectedly. These are women in their 20s, many mothers of young children who come in to work every day, middle aged women who have seen it all and done it all twice. There are senior nurses, some back from retirement because they could not sit home and allow someone else to do it alone. I cannot express in words the admiration I have for these practitioners. They do not get a round of applause like I did when I managed to take a temperature and helped a man avoid peeing on the floor. They are getting some recognition now but not nearly enough. They are the cornerstones in this battle against this disease. These daughters, mothers and sisters are the front line, down in the trenches soldiers carrying the heavy loads and doing so willingly and without complaint. They deserve any accolade that might be sent their way and a hundred times more for each of the mercies they complete. So If you read this and you know a nurse text her, phone her, send her a card and give her a heartfelt but in these times, a virtual hug and a round of applause. It made me, someone who was only a 7 minute nurse, know that someone was watching and appreciating the effort, I think the 24/7 nurses deserve much more than that.

I am a drinker of Diet Coke but during this crisis I have given it up. I am drinking lots more very cold water and it seems to be doing quite well for me. I do miss the caffeine rush occasionally but I can go to coffee for that if need be. I used to drink four to five cans of Diet Coke per day.

We are using it. It is not a miracle drug but it is the best we have along with Tocilizumab. Notice what is not in that sentence? Plaquenyl (hydroxycloroquine). While still in use it is generally felt to offer little in the overall treatment and so Dr. Fauci appears to have been right when he warned at the WH press conference that the drug's effectiveness was only anecdotal. This drug does have good initial scientific evidence of effectiveness. Hopefully some people will learn that the science matters. Problem with Remdesivir is that manufacturing of it is very limited right now, the chemicals needed to make it are hard to come by and most of them are held in large part by China.

Interesting that since the CoVid pandemic, we have seen a drop in alcohol related admissions to the hospital to almost nil. Usually there would be two to three a day. About 13% of the people in the US have alcohol related problems. So staying home and drinking or not drinking seems to be keeping people out of the hospital. If they are drinking at home, they usually do not get seen, they pass out and wake up and start drinking again so withdrawal is not the problem. Alcohol induced pancreatitis and other toxicities not related to withdrawal are still a problem but those patients have not been showing up. Also people are not going to bars so alcohol consumption on a social basis is probably way down. I would guess police calls about street fights and public intoxication are way down as well. In addition, our usual cadre of drug seeking patients are way down. In order to get to be seen in the ER they have to go through a screening area in a tent outside the ER. Then they need to risk coming into a ER filled with Covid patients. They may be drug seekers but there are apparently barriers they will not climb to feed the habit.

The number of swine flu deaths in the US was about 13000. Worldwide it was much higher due to mostly deaths in China. Deaths being reported out of China with Covid 19 are much less a percentage of the people killed either because China became better adept of controlling the spread or because they are underreporting the number of deaths or because both are true. Clearly US deaths from Covid 19 will be several times higher than the Swine flu and with a much greater effort to control it. Worldwide, it is likely to exceed the number of deaths as well. This will certainly be true if the disease takes a hard toll on Africa which was relatively spared from the swine flu.

Well Lunch is over. We ate outdoors. He was in the house for a very short period of time mostly to use the facilities. All plates and utensils immediately went into the dishwasher and were washed at the hottest settings and will not be used for more than 48 hours. The last load of dishes was in there clean for at least one week. We kept social distances and spoke across the table about 8 to 10 feet apart. I will not be using that outdoor table for quite some time. Last time I used it was more than one month ago. So I feel as though this was a safe and sane encounter.

He was quite coherent when I saw him but not a big conversationalist. His body however spoke volumes. With social isolation who knows what is going on in people's lives. In New Jersey they considered Liquor stores essential and kept them open and gun shops were also deemed essential. . Nice to know that there may be drunk people able to buy a gun in this state. To the point, I have seen Steve on two occasions. One time we both had a few drinks and the next times, though I offered he declined. He was a nice guy but I did not go into a long history of his life. While his responses to you were odd, I would not be quick to attribute them to a chronic drug or alcohol problems. For example, I have made nonsensical responses to texts and phone calls when I was very tired or just woken from sleep or distracted by something else. It seems clear he was not at his best but there is not sufficient reason to assume to worst.

I have a childhood friend coming to visit today. I have an outdoor front porch where we will be sitting across a table from one another to eat. No common utensils. Social distancing and social discourse and then good bye. No touching. He probably will not go in the house unless it is to use the guest bathroom, which I do not use. He has been in virtual quarantine for weeks and I have not because of my job so most of the risk is his. Neither one of us is sick but of course the is not an assured situation. Is this risky behavior? Probably so but I believe the risk is minimal and it is the kind of risk we will all be taking when things open up again.

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.